Factors influencing prognosis after neo-adjuvant chemoradiation therapy for rectal carcinoma

Neo-adjuvant chemoradiation therapy (CRTx) has become a standard therapeutic regimen for rectal carcinoma. This therapeutic option allows more sphincter preserving surgical procedures and seems to improve prognosis in patients with rectal carcinoma. The aim of this study is to analyse factors influencing prognosis in terms of disease free survival (DFS) and overall survival (OS) after CRTx.

We have reviewed the clinical and morphological data of 39 patients after neo-adjuvant chemoradiation therapy, including immunohistochemistry for p53, cyclin D1, MIB-1 (Ki67) and bcl-2 protein in paraffin-embedded tissue.

In our series, 12 patients did not respond to neo-adjuvant therapy, 12 showed a complete response and 15 a partial response. When we analysed the factors influencing DFS we found a significant influence of neural, vascular and lymphatic invasion, pre-operative and postoperative CEA, TNM staging, smoking and histological response to CRXT in the univariate analysis. As for OS, we found a significant influence of TNM staging, histological grade, peritumoral inflammatory reaction and vascular and neural invasion. No multivariate analysis was performed due to the small sample size.

In our series of patients with rectal carcinoma receiving pre-operative chemoradiation therapy, histopathological response has influenced prognosis.