Evidence map›Paper›PMID 28819868›Full record

ArticleTechniques in coloproctology2017

One-level step section histological analysis is insufficient to confirm complete pathological response after neoadjuvant chemoradiation for rectal cancer.

M A Pereira, A R Dias, S F Faraj, C S R Nahas, A R Imperiale, C F S Marques, G C Cotti, B C Azevedo, S C Nahas, E S de Mello and 1 more

Erratum issuedAbstract readEvaluation Study
PubMed Publisher
In one paragraph

Article in Techniques in coloproctology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.2field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 4 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

M A PereiraDepartment of Pathology, Cancer Institute, University of Sao Paulo, Avenida Dr Arnaldo, 251, São Paulo, SP, 01246-000, Brazil. ma.ap@hotmail.com.
A R DiasDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
S F FarajDepartment of Pathology, Cancer Institute, University of Sao Paulo, Avenida Dr Arnaldo, 251, São Paulo, SP, 01246-000, Brazil.
C S R NahasDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
A R ImperialeDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
C F S MarquesDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
G C CottiDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
B C AzevedoDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
S C NahasDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
E S de MelloDepartment of Pathology, Cancer Institute, University of Sao Paulo, Avenida Dr Arnaldo, 251, São Paulo, SP, 01246-000, Brazil.
U RibeiroDepartment of Gastroenterology, Cancer Institute, University of Sao Paulo, São Paulo, Brazil.
Universidade de São Paulo · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeoadjuvant chemoradiation therapy (nCRT) for rectal cancer may lead to cure. As we currently lack reliable methods to clinically confirm the absence of disease, some patients undergo radical resection and have pathological complete response (pCR) still undergo surgery. Furthermore, it is uncertain if conventional one-level histopathological analysis is accurate enough to determine complete response. Confirming pCR is essential to determine the prognosis and to consider the patient's inclusion in trials of adjuvant therapy. The aim of this study was to determine whether the current 1-level approach is sufficient to confirm pCR.

methodsFour hundred and thirty-five patients with rectal cancer who received nCRT followed by radical resection were analyzed. All cases identified as pCR by 1-level step section histological evaluation were reassessed with 3-level step sections and immunohistochemical analysis to verify the presence of residual disease.

resultsOut of 435 patients, 75 (17.2%) were staged as ypT0. Of these, 6 had lymph node involvement and 1 had distant metastasis, leaving 68 (15.6%) who had pCR. After the additional step sections, residual tumor was detected in 12 (17.6%) of these 68. The final pCR rate was 12.9%. Distant recurrence was detected in 7.1% of real-pCR patients compared to 16.7% in the false-pCR group (p = 0.291). Sensitivity of clinical assessment for detecting pCR was 35.7%, and the accuracy of 1-section histological evaluation to identify pCR was 82.4%.

conclusionsHistopathological analysis with 1-level step section is insufficient to determine complete tumor eradication. The 3-level sections methodology revealed residual tumor cells in patients initially classified as ypT0. Further studies with larger sample size are required to verify the clinical relevance of these residual tumor cells. Caution should continue to be applied to watch and wait strategies following nCRT.

Indexed as

AdultAgedAged, 80 and overChemoradiotherapy, AdjuvantColectomyFemaleHumansMaleMiddle AgedNeoadjuvant TherapyNeoplasm Recurrence, LocalNeoplasm, ResidualNeoplasm StagingPrognosisProspective StudiesRectal NeoplasmsComplete responseNeoadjuvant therapyPathologic responseRectal cancerWatch and wait

Identifiers

PMID28819868
OpenAlexW4252298550

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.