Predicción de supervivencia en cáncer de recto localmente avanzado a través de factores clínicos pronósticos

Enrico Hernández; Gustavo Gotera; Carmen Luces

doi:10.37910/RDP.2026.15.1.e441

Authors

Enrico Hernández Instituto Oncológico Luis Razetti
Gustavo Gotera Instituto Oncológico Luis Razetti
Carmen Luces Instituto Oncológico Luis Razetti

DOI:

https://doi.org/10.37910/RDP.2026.15.1.e441

Keywords:

Rectal cancer, prognostic factors,, neoadjuvant treatment

Abstract

Knowledge of the prognostic and predictive factors in rectal cancer is imperative for its current therapy Objective: To evaluate the variables that influence as a prognostic factor in patients diagnosed with locally advanced rectal cancer. Methods: The sample consisted of 27 patients. The data is selected through frequency distribution tables. Univariable and multivariable analysis and Kapplan Meier will be used as statistics. Results: The delay between radiotherapy and surgery was statistically significant (p = 0.003), it was more common than the patients who were taken to surgery after 10 weeks after completing the radiotherapy (65.2%) without getting a response pathological complete. Discussion: In this study four basic factors of good prognosis were identified: the response to neoadjuvant treatment, the delay between the end of radiotherapy and surgery less than 10 weeks, the use of neoadjuvant capecitabine and the non-speed of carcino embryonic antigen over 5 ng / dL.

References

1. Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, et al. SEER Cancer statistics review, 1975-2016 [Internet]. Bethesda: National Cancer Institute; 2019 [consultado 30 mayo 2019]. Disponible en: https://seer.cancer.gov/csr/1975_2016/.

2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: Cancer J Clin [Internet]. Sep 2018 [consultado 20 may 2019]; 68(6):394-424. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492.

3. Yahya J, Herzig D, Farrell M, Degnin C, Chen Y, Holland J, et al. Survey results of US radiation oncology providers' contextual engagement of watch-and-wait beliefs after a complete clinical response to chemoradiation in patients with local rectal cancer. J Gastrointest Oncol. Dic 2018; 9(6):1127-1132 doi: 10.21037/jgo.2018.08.02.

4. Renehan AG, Malcomson L, Emsley R, Gollins S, Maw A, Myint AS, et al. Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis. Lancet Oncol. Feb 2016; 17(2):174-183. doi: 10.1016/S1470-2045(15)00467-2

5. Bosset JF, Collette L, Calais G, Mineur L, Maingon P, Radosevic-Jelic L, et al. Chemotherapy with preoperative radiotherapy in rectal cancer. N Engl J Med. 2006; 355:1114-1123. doi: 10.1056/NEJMoa060829.

6. Sauer R, Becker H, Hohenberger W, Rödel C, Wittekind C, Fietkau R, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med. 2004; 351:1731-1740. doi: 10.1056/NEJMoa040694.

7. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol. 1 jun 2012; 30(16):1926-33. doi: 10.1200/JCO.2011.40.1836.

8. Díaz R, Akhoundova D, Bruixola G, Aparicio J. Controversies in the multimodality management of locally advanced rectal cancer. Med Oncol. Jun 2017; 34(6):102. doi: 10.1007/s12032-017-0964-8

9. Bosset JF, Calais G, Mineur L, Maingon P, Stojanovic-Rundic S, Bensadoun RJ, et al. Fluorouracil-based adjuvant chemotherapy after preoperative chemoradiotherapy in rectal cancer: long-term results of the EORadioterapiaC 22921 randomised study. Lancet Oncol. Feb 2014; 15(2):184-90. doi: 10.1016/S1470-2045(13)70599-0

10. Seung-Gu Y, Dae YK, Tae HK, Hee JC, Jae HO, Won P, et al. Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer. Long-term outcomes and prognostic significance of pathologic nodal status (KROG 09-01). Ann Surg. 2010; 252:998–1004. doi: 10.1097/SLA.0b013e3181f3f1b1.

11. Park IJ, You YN, Agarwal A, Skibber JM, Rodriguez-Bigas MA, Eng C, et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer. J Clin Oncol. May 2012; 30:1770-1776. doi: 10.1016/j.urolonc.2013.03.009.

12. Maradioterapiain ST, Heneghan HM, Winter DC. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. British Journal of Surgery [Internet]. Feb 2012 [consultado 13 jul 2019]; 99: 918–928. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/bjs.8702.

13. Cienfuegos JA, Baixauli J, Pastor C, Arredondo J, Sola JJ, Arbea L, et al. Resultados oncológicos a largo plazo en el cáncer de recto tratado con quimio-radioterapia preoperatoria y cirugía: análisis de 500 casos. Rev esp enferm dig. 2015; 107(6): 340 - 346. [consultado 14 jul 2019]; Disponible en https://pubmed.ncbi.nlm.nih.gov/26031861/

14. Zeng WG, Liang JW, Wang Z, Zhang XM, Hu JJ, Hou HR, et al. Clinical parameters predicting pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Chin J Cancer. 2015; 34:41. doi: 10.1186/s40880-015-0033-7

15. Tan Y, Fu D, Li D, Kong X, Jiang K, Chen L, et al. Predictors and risk factors of pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer: a population-based analysis. Front Oncol [Internet]. Jun 2019 [consultado 14 jul 2019]; 9:497. Disponible en: https://www.frontiersin.org/aradioterapiaicles/10.3389/fonc.2019.00497/full.

16. Figueroa MC, Briceño JB, Puerta DI, Hurtado WD, Sánchez NO, Rodríguez AI, et al. Radioterapia y quimioterapia preoperatoria en cáncer de recto. Rev Venez Oncol. 2015; 27(1):11-21. [en linea]. [ Consultado 9 de marzo de 2019]. ISSN: 0798-0582. Disponible en: https://www.redalyc.org/articulo.oa?id=375637056003

17. Gil A, Delgado R, Russo L. Primera experiencia venezolana en manejo no quirúrgico del cáncer de recto con respuesta clínica completa posterior a terapia neoadyuvante. Rev Venez Oncol. 2017; 29(1):65-75 [enlinea].[ Consultado 15 de julio de 2019] Disponible en https://www.redalyc.org/journal/3756/375649739011/html/

18. Reyes R, Urdaneta N, Aguirre L, Hernández C, Vera A, Ott I, et al. Tratamiento con radioterapia quimioterapia neoadyuvante vs. Adyuvante en adenocarcinoma de recto. Experiencia de 15 años. Rev Venez Oncol. 2019; 1. [en linea]. [Consultado 01 de julio de 2019].ISSN:0798-0582.Disponibleen:https://www.redalyc.org/articulo.oa?id=375657637011

19. Li Y, Wang J, Ma X, Tan L, Yan Y, Xue C, et al. A review of neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Int J Biol Sci. 17 jul 2016; 12(8):1022-31. doi: 10.7150/ijbs.15438. PubMed PMID: 27489505; PubMed Central PMCID: PMC4971740.

20. Al-Sukhni E, Attwood K, Mattson DA, Gabriel E, Nurkin SJ. Predictors of pathologic complete response following neoadjuvant chemoradiotherapy for rectal cancer. Ann Surg Oncol. 2016; 23(4): 1177–1186. doi: 10.1245/s10434-015-5017-y

21. National Comprehensive Cancer Network (NCCN) [Internet]. NCCN Clinical Practice Guidelines in Oncology. Rectal Cancer Version 2.2019. [consultado 14 jul 2019]. Disponible en: https://www.nccn.org/professionals/physician_gls/pdf/rectal.pdf.

22. Joye I, Haustermans K. Which Patients With Rectal Cancer Do Not Need Radiotherapy?. Semin Radiat Oncol [Internet]. 2016 [citado 2 jun 2019]; 26(3): 199-204. Disponible en: http://dx.doi.org/10.1016/j.semradonc.2016.02.006. DOI: 10.1016/j.semradonc.2016.02.006