Value of ypTNM stage in patients with rectal cancer

Abstract Purpose: In the current NCCN guidelines, the prognosis and adjuvant chemotherapy regimen of patients who underwent neoadjuvant chemoradiotherapy, which are based on pre-radiotherapy clinical TNM stage or neoadjuvant pathologic TNM stage, are not clearly described. We investigated neoadjuvant pathologic TNM stage and clinical TNM stage, which can better reflect the prognosis of patients. Moreover, the clinical significance of the adjuvant chemotherapy regimen in different neoadjuvant pathologic TNM stages was studied. Methods: Between 2010 and 2015, a total of 316 rectal cancer patients who underwent neoadjuvant chemoradiotherapy, followed by radical resection, were retrospectively studied. Results: Our findings revealed that neoadjuvant pathologic TNM stage was a more important prognostic factor than clinical TNM stage. In different neoadjuvant pathologic TNM stages, adjuvant chemotherapy played important roles in stage-II and -III disease, but played no significant role in pCR and stage-I disease. Conclusion: Neoadjuvant pathologic TNM stage, rather than clinical TNM stage, was a more important prognostic factor. Among the patients who underwent neoadjuvant chemoradiotherapy, adjuvant chemotherapy had no significant benefit on the survival of patients in terms of pCR and neoadjuvant pathologic TNM stage I, but had different benefits in stage-II and -III disease.