{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:15:49Z","timestamp":1753888549350,"version":"3.41.2"},"reference-count":49,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Cir. Bras."],"abstract":"<jats:p>ABSTRACT  Purpose: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT).  Methods: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes.  Results: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng\/mL with DFS and MFS, pT3\/pT4 staging with DFS, MFS and SEN, pN1\/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN.  Conclusion: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.<\/jats:p>","DOI":"10.1590\/acb401125","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T16:39:26Z","timestamp":1739291966000},"source":"Crossref","is-referenced-by-count":0,"title":["Analysis of clinical and pathological prognostic factors of survival in rectal adenocarcinoma treated with preoperative radiochemotherapy"],"prefix":"10.1590","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0395-6799","authenticated-orcid":false,"given":"Sarhan Sydney","family":"Saad","sequence":"first","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9414-0343","authenticated-orcid":false,"given":"Nora","family":"Forones","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9344-6479","authenticated-orcid":false,"given":"Gaspar","family":"Lopes Filho","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2775-8068","authenticated-orcid":false,"given":"Jaques","family":"Waisberg","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1414-8092","authenticated-orcid":false,"given":"Elesiario","family":"Caetano J\u00fanior","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4378-076X","authenticated-orcid":false,"given":"Ricardo","family":"Artigiani-Neto","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0117-8786","authenticated-orcid":false,"given":"Delcio","family":"Matos","sequence":"additional","affiliation":[{"name":"Universidade Federal de S\u00e3o Paulo,  Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"1","key":"ref1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21708","article-title":"Cancer statistics, 2022","volume":"72","author":"Siegel RL","year":"2022","journal-title":"CA Cancer J Clin"},{"year":"2022","series-title":"INCA","key":"ref2"},{"issue":"8514","key":"ref3","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/S0140-6736(86)92612-7","article-title":"Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumor spread and surgical excision","volume":"2","author":"Quirke P","year":"1986","journal-title":"Lancet"},{"issue":"1","key":"ref4","first-page":"45","article-title":"Do all locally advanced rectal cancers require radiation? 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YH","year":"2010","journal-title":"Ann Surg"},{"issue":"4","key":"ref32","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.ijrobp.2009.06.019","article-title":"Pathologic nodal classification is the most discriminating prognostic factor for disease- free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection","volume":"77","author":"Kim TH","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"issue":"2","key":"ref33","doi-asserted-by":"crossref","first-page":"104","DOI":"10.4143\/crt.2012.44.2.104","article-title":"Preoperative concurrent chemoradiotherapy for locally advanced rectal cancer: treatment outcomes and analysis of prognostic factors","volume":"44","author":"Kong M","year":"2012","journal-title":"Cancer Res Treat"},{"issue":"12","key":"ref34","doi-asserted-by":"crossref","DOI":"10.1093\/jnci\/djw171","article-title":"Long-term Outcome of an Organ Preservation Program After Neoadjuvant Treatment for Rectal Cancer","volume":"108","author":"Martens MH","year":"2016","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"ref35","doi-asserted-by":"crossref","DOI":"10.1001\/jamaoncol.2018.5896","article-title":"Assessment of a watch-and-wait strategy for rectal cancer in patients with a complete response after neoadjuvant therapy","volume":"5","author":"Smith JJ","year":"2019","journal-title":"JAMA Oncol"},{"issue":"5","key":"ref36","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1097\/DCR.0000000000001594","article-title":"Oncological outcomes and hospital costs of the treatment in patients with rectal cancer: watch-and-wait policy and standard surgical treatment","volume":"63","author":"Hupkens BJP","year":"2020","journal-title":"Dis Colon Rectum"},{"issue":"12","key":"ref37","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.1097\/DCR.0000000000002122","article-title":"Organ preservation in patients with rectal cancer treated with total neoadjuvant 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preoperative treatment","volume":"43","author":"Dulk M","year":"2007","journal-title":"Eur J Cancer"},{"issue":"3","key":"ref41","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.radonc.2009.11.005","article-title":"Prognostic impact of peritonealisation in rectal cancer treated with preoperative chemoradiotherapy: extraperitoneal versus intraperitoneal rectal cancer","volume":"94","author":"Hwang MR","year":"2010","journal-title":"Radiother Oncol"},{"issue":"6","key":"ref42","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.ejso.2012.03.002","article-title":"Lymph node ratio is an independent prognostic factor in patients with rectal cancer treated with preoperative chemoradiotherapy and curative resection","volume":"38","author":"Lee SD","year":"2012","journal-title":"Eur J Surg Oncol"},{"issue":"3","key":"ref43","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s00268-011-1409-8","article-title":"Partial pathologic response and nodal status as most significant prognostic factors for advanced rectal cancer treated with preoperative chemoradiotherapy","volume":"36","author":"Huebner M","year":"2012","journal-title":"World J Surg"},{"issue":"2","key":"ref44","article-title":"Poorer oncologic outcome of good responders to pcrt with remnant lymph nodes defies the oncologic paradox in patients with rectal cancer","volume":"18","author":"Cho E","year":"2019","journal-title":"Clin Colorectal Cancer"},{"issue":"4","key":"ref45","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1002\/jso.26932","article-title":"T-stage downstaging of locally advanced rectal cancer after neoadjuvant chemoradiotherapy is not associated with reduced recurrence after adjusting for tumour characteristics","volume":"126","author":"Hayes IP","year":"2022","journal-title":"J Surg Oncol"},{"issue":"4","key":"ref46","doi-asserted-by":"crossref","first-page":"603","DOI":"10.21037\/jgo.2016.05.03","article-title":"Pathologic response to 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