Complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer and systemic oncologic benefit: a retrospective cohort study in Korea.
4 affiliations
- 1Colorectal Cancer Center, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
- 2Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea
- 3Department of Hematology/Oncology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
- 4Department of Pathology, Kyungpook National University Chilgok Hospital, Kyungpook National University School of Medicine, Daegu, Korea
Abstract
Purpose
Neoadjuvant chemoradiotherapy (CRT) improves local control in locally advanced rectal cancer (LARC) but has not consistently demonstrated a survival benefit. This study evaluated whether pathological complete response (ypCR) after CRT confers systemic oncological benefit beyond local tumor control.Methods
A total of 1,105 patients with clinically staged T3 or node-positive rectal cancer who underwent total mesorectal excision at a single tertiary center between 2004 and 2019 were categorized into 3 groups: no CRT (n=608), non-ypCR (n=414), and ypCR (n=83). Primary outcomes were 5-year overall survival (OS) and relapse-free survival (RFS). Secondary outcomes were 5-year cumulative incidences of local recurrence and distant metastasis.Results
Five-year OS rates were 77.6%, 82.0%, and 95.7% in the no-CRT, non-ypCR, and ypCR groups, respectively. The ypCR group demonstrated superior OS compared with both no-CRT and non-ypCR groups (P=0.001 and P=0.007, respectively). The marginal OS difference between the no-CRT and non-ypCR groups (P=0.047) was no longer significant after multivariable adjustment (hazard ratio, 0.903; P=0.622). Five-year RFS rates were 69.6%, 72.5%, and 91.1% in the no-CRT, non-ypCR, and ypCR groups, respectively. The 5-year cumulative incidence of distant metastasis was lower in the ypCR group (7.5%) than in the no-CRT and non-ypCR groups (23.8% and 25.0%, respectively; P=0.005). On multivariable analysis, ypCR remained independently associated with reduced risks of death, relapse, and distant metastasis.Conclusion
The ypCR after neoadjuvant CRT in LARC was associated with superior survival and reduced distant metastasis, suggesting effective systemic tumor control rather than a local treatment effect alone.
Related
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BibTeX
@article{song2026complete,
title = {{Complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer and systemic oncologic benefit: a retrospective cohort study in Korea.}},
author = {Seung Ho Song and Jun Seok Park and Soo Yeun Park and Hye Jin Kim and Sung-Min Lee and Min Kyu Kang and Jong Gwang Kim and An Na Seo and Gyu-Seog Choi},
journal = {Annals of coloproctology},
year = {2026},
month = oct,
doi = {10.3393/ac.2026.00549.0078},
url = {https://europepmc.org/article/MED/42958781},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer and systemic oncologic benefit: a retrospective cohort study in Korea.
AU - Seung Ho Song
AU - Jun Seok Park
AU - Soo Yeun Park
AU - Hye Jin Kim
AU - Sung-Min Lee
AU - Min Kyu Kang
AU - Jong Gwang Kim
AU - An Na Seo
AU - Gyu-Seog Choi
PY - 2026
DA - 2026/10/01
JO - Annals of coloproctology
DO - 10.3393/ac.2026.00549.0078
UR - https://europepmc.org/article/MED/42958781
AB - Purpose Neoadjuvant chemoradiotherapy (CRT) improves local control in locally advanced rectal cancer (LARC) but has not consistently demonstrated a survival benefit. This study evaluated whether pathological complete response (ypCR) after CRT confers systemic oncological benefit beyond local tumor control.Methods A total of 1,105 patients with clinically staged T3 or node-positive rectal cancer who underwent total mesorectal excision at a single tertiary center between 2004 and 2019 were categorized into 3 groups: no CRT (n=608), non-ypCR (n=414), and ypCR (n=83). Primary outcomes were 5-year overall survival (OS) and relapse-free survival (RFS). Secondary outcomes were 5-year cumulative incidences of local recurrence and distant metastasis.Results Five-year OS rates were 77.6%, 82.0%, and 95.7% in the no-CRT, non-ypCR, and ypCR groups, respectively. The ypCR group demonstrated superior OS compared with both no-CRT and non-ypCR groups (P=0.001 and P=0.007, respectively). The marginal OS difference between the no-CRT and non-ypCR groups (P=0.047) was no longer significant after multivariable adjustment (hazard ratio, 0.903; P=0.622). Five-year RFS rates were 69.6%, 72.5%, and 91.1% in the no-CRT, non-ypCR, and ypCR groups, respectively. The 5-year cumulative incidence of distant metastasis was lower in the ypCR group (7.5%) than in the no-CRT and non-ypCR groups (23.8% and 25.0%, respectively; P=0.005). On multivariable analysis, ypCR remained independently associated with reduced risks of death, relapse, and distant metastasis.Conclusion The ypCR after neoadjuvant CRT in LARC was associated with superior survival and reduced distant metastasis, suggesting effective systemic tumor control rather than a local treatment effect alone.
SN - 2287-9714
SN - 2287-9722
ER -