Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer

Background: We investigated the relationship between pathologic T-stage and mesorectal inetastases after preoperative chemoradiotherapy (CRT) for clinical stage 11 to III rectal carcinoma. Methods: The records of consecutive patients with clinical stage 11 to III carcinoma of the mid or low rectum who underwent surgery after CRT were reviewed. Indications for preoperative CRT were cancer LIP to I I cm from the anal verge, Eastern Cooperative Oncology Group performance status Of 0 to 2, age 18 to 75 years, and clinical tumor-node-metastasis stage II or III. Results: The study group consisted of 235 patients (148 men and 87 women; median age, 61 years). The pretreatment tumor-node-metastasis stage was as follows: I, n = 1; II, n = 96; and 111, n = 138. Radiotherapy was delivered at a median dose of 50.4 Gy. A pathologic complete response on the rectal wall was found in 24% of patients, and nodal inetastases were found in 20% of patients. According to the pT stage, the rate of node positivity was 2% for pT0, 15% for pT1 17% for pT2, 38% for pT3, and 33% for pT4 cases. At multivariate analysis, the best model for predicting pathologic node involvement included young age, positive pretreatment N status, and pT status. On considering pT stage alone, the odds ratio was in the region of 10 for pT1/2 and >20 for pT3/4 patients. Conclusions: In patients with PTO after preoperative CRT for clinical stage H to III mid or low rectal cancer, the risk of nodal metastases is very low. More conservative surgery (local excision) may be considered in these cases.