# The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection.

**Tumor:** Cáncer rectal
**Autores:** Zeman M, Czarnecki M, Chmielik E et al
**Revista:** World J Surg Oncol (2021)
**PMID:** 34020673 | **PMCID:** PMC8140444
**DOI:** [10.1186/s12957-021-02262-x](https://doi.org/10.1186/s12957-021-02262-x)
**Fuente:** PubMed Central (open access)

## Relevancia
Tumor rectal post-quimiorradioterapia neoadyuvante: aporta evidencia sobre la conversión cN+ → ypN0 en el mesorrecto, valor pronóstico de la respuesta ganglionar y selección de pacientes para watch-and-wait u organ preservation. Paralelo al carcinoma de mama: la respuesta ganglionar tras NAC es un marcador pronóstico independiente y modula la cirugía locorregional.

## Abstract
The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection.

A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL).

In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15-15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25-23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72-8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97-12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44-34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94-9.53, p < 0.001).

Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

## Acceso
Disponible en PMC: https://pmc.ncbi.nlm.nih.gov/articles/PMC8140444/

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*Datos de PubMed. Citar: doi 10.1186/s12957-021-02262-x*
