Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone

Aviram Nissan, Alexander Stojadinovic, Jinru Shia, Axel Hoos, Jose G. Guillem, David Klimstra, Alfred M. Cohen, Bruce D. Minsky, Philip B. Paty, W. Douglas Wong

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Abstract

Purpose: Treatment of rectal cancer with neoadjuvant radiotherapy has been shown to reduce local recurrence and improve overall survival. The role of chemoradiotherapy in patients with T2, N0 and early T3, N0 rectal cancer, treated by radical surgery with total mesorectal excision, remains controversial. The aim of this study was to identify predictors of recurrence in this group of patients to enhance treatment selection. Patients and Methods: One hundred patients with primary T2-3, N0 adenocarcinoma of the rectum, uniformly treated by surgery alone, were studied. The pathology slides available for 97 patients were rereviewed. Three patients with incomplete data sets were excluded. Clinical and survival data were obtained from a prospective computerized database and updated from hospital and office charts. The study end points were disease-free survival, disease-specific survival (DSS), time to pelvic recurrence (PR), and distant recurrence. Results: Complete follow-up was available for all study patients. Median follow-up was 79.5 months (range, 57.7 to 105.9 months). During this time period 30 patients (31.9%) died as a result of disease and 64 patients (68.1 %) remained alive and disease free. Five-year DSS was 73%. The cumulative risk for PR was 8% at 5 years and 10% at 8 years. Lymphovascular invasion, preoperative serum carcinoembryonic antigen (CEA > 5 ng/mL) level, and age older than 70 years were all associated with adverse outcome. Conclusion: Patients with T2-3, N0 rectal cancers and either lymphovascular invasion or elevated CEA levels have reduced survival and a higher incidence of PR, and should be considered for future randomized trials.

Original languageEnglish (US)
Pages (from-to)4078-4084
Number of pages7
JournalJournal of Clinical Oncology
Volume24
Issue number25
DOIs
StatePublished - Sep 1 2006

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Rectum
Adenocarcinoma
Recurrence
Rectal Neoplasms
Survival
Carcinoembryonic Antigen
Chemoradiotherapy
Disease-Free Survival
Radiotherapy
Databases
Pathology
Incidence
Therapeutics
Serum

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Nissan, A., Stojadinovic, A., Shia, J., Hoos, A., Guillem, J. G., Klimstra, D., ... Wong, W. D. (2006). Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone. Journal of Clinical Oncology, 24(25), 4078-4084. https://doi.org/10.1200/JCO.2006.06.2968

Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone. / Nissan, Aviram; Stojadinovic, Alexander; Shia, Jinru; Hoos, Axel; Guillem, Jose G.; Klimstra, David; Cohen, Alfred M.; Minsky, Bruce D.; Paty, Philip B.; Wong, W. Douglas.

In: Journal of Clinical Oncology, Vol. 24, No. 25, 01.09.2006, p. 4078-4084.

Research output: Contribution to journalArticle

Nissan, A, Stojadinovic, A, Shia, J, Hoos, A, Guillem, JG, Klimstra, D, Cohen, AM, Minsky, BD, Paty, PB & Wong, WD 2006, 'Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone', Journal of Clinical Oncology, vol. 24, no. 25, pp. 4078-4084. https://doi.org/10.1200/JCO.2006.06.2968
Nissan, Aviram ; Stojadinovic, Alexander ; Shia, Jinru ; Hoos, Axel ; Guillem, Jose G. ; Klimstra, David ; Cohen, Alfred M. ; Minsky, Bruce D. ; Paty, Philip B. ; Wong, W. Douglas. / Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 25. pp. 4078-4084.
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AU - Stojadinovic, Alexander

AU - Shia, Jinru

AU - Hoos, Axel

AU - Guillem, Jose G.

AU - Klimstra, David

AU - Cohen, Alfred M.

AU - Minsky, Bruce D.

AU - Paty, Philip B.

AU - Wong, W. Douglas

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N2 - Purpose: Treatment of rectal cancer with neoadjuvant radiotherapy has been shown to reduce local recurrence and improve overall survival. The role of chemoradiotherapy in patients with T2, N0 and early T3, N0 rectal cancer, treated by radical surgery with total mesorectal excision, remains controversial. The aim of this study was to identify predictors of recurrence in this group of patients to enhance treatment selection. Patients and Methods: One hundred patients with primary T2-3, N0 adenocarcinoma of the rectum, uniformly treated by surgery alone, were studied. The pathology slides available for 97 patients were rereviewed. Three patients with incomplete data sets were excluded. Clinical and survival data were obtained from a prospective computerized database and updated from hospital and office charts. The study end points were disease-free survival, disease-specific survival (DSS), time to pelvic recurrence (PR), and distant recurrence. Results: Complete follow-up was available for all study patients. Median follow-up was 79.5 months (range, 57.7 to 105.9 months). During this time period 30 patients (31.9%) died as a result of disease and 64 patients (68.1 %) remained alive and disease free. Five-year DSS was 73%. The cumulative risk for PR was 8% at 5 years and 10% at 8 years. Lymphovascular invasion, preoperative serum carcinoembryonic antigen (CEA > 5 ng/mL) level, and age older than 70 years were all associated with adverse outcome. Conclusion: Patients with T2-3, N0 rectal cancers and either lymphovascular invasion or elevated CEA levels have reduced survival and a higher incidence of PR, and should be considered for future randomized trials.

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