BACKGROUND: In rectal cancer patients anterior resection with total mesorectal excision (TME) results in good functional outcomes, optimal local control and improved survival. However, patients with locally advanced tumours still have a high risk of oncological relapse and may benefit from neo- or adjuvant therapy. AIM. The purpose of this study was to identify the clinico-pathological features related to poor prognosis after sphincter-saving curative combined-modality therapy for rectal cancer. MATERIAL AND METHOD: Forty-eight consecutive patients with UICC stage II and III rectal carcinoma operated on with TME were studied prospectively. Fifteen patients received neoadjuvant radiotherapy and postoperative chemotherapy; for the remainder combined adjuvant chemoradiotherapy was given. RESULTS: Five-year cancer-specific survival rate was 49%. Patient's gender, tumour location, grade, mucinous histology, direct tumour spread, type of growth margin and lymphocytic tumour infiltration were revealed to be factors without statistical importance. Only the positive nodal status (31.6 +/- 11.0 vs 61.5 +/- 9.7) and the patient's advanced age (38.5 +/- 9.7 vs 63.2 +/- 11.4) were significantly related to decreased survival rate (p=0.038 and 0.048, respectively). In multivariate analysis both parameters independently influenced poor prognosis (p=0.045 and 0.038; Relative Risk 2.26 and 2.13; Odds Ratio 4.21 and 1.07, respectively). CONCLUSIONS: An elderly patient's age seems to be an independent prognostic factor associated with poor survival after curative treatment for locally advanced rectal cancer even when non-cancer causes of death are excluded. Thus, for older patients adjuvant therapy should be an integral part of treatment with the careful benefit-toxicity analysis.
BACKGROUND: In rectal cancerpatients anterior resection with total mesorectal excision (TME) results in good functional outcomes, optimal local control and improved survival. However, patients with locally advanced tumours still have a high risk of oncological relapse and may benefit from neo- or adjuvant therapy. AIM. The purpose of this study was to identify the clinico-pathological features related to poor prognosis after sphincter-saving curative combined-modality therapy for rectal cancer. MATERIAL AND METHOD: Forty-eight consecutive patients with UICC stage II and III rectal carcinoma operated on with TME were studied prospectively. Fifteen patients received neoadjuvant radiotherapy and postoperative chemotherapy; for the remainder combined adjuvant chemoradiotherapy was given. RESULTS: Five-year cancer-specific survival rate was 49%. Patient's gender, tumour location, grade, mucinous histology, direct tumour spread, type of growth margin and lymphocytic tumour infiltration were revealed to be factors without statistical importance. Only the positive nodal status (31.6 +/- 11.0 vs 61.5 +/- 9.7) and the patient's advanced age (38.5 +/- 9.7 vs 63.2 +/- 11.4) were significantly related to decreased survival rate (p=0.038 and 0.048, respectively). In multivariate analysis both parameters independently influenced poor prognosis (p=0.045 and 0.038; Relative Risk 2.26 and 2.13; Odds Ratio 4.21 and 1.07, respectively). CONCLUSIONS: An elderly patient's age seems to be an independent prognostic factor associated with poor survival after curative treatment for locally advanced rectal cancer even when non-cancer causes of death are excluded. Thus, for older patients adjuvant therapy should be an integral part of treatment with the careful benefit-toxicity analysis.
Authors: Bartlomiej Szynglarewicz; Rafal Matkowski; Agnieszka Halon; Aleksandra Lacko; Marcin Stepien; Jozef Forgacz; Marek Pudelko; Jan Kornafel Journal: Pathol Oncol Res Date: 2009-09-15 Impact factor: 3.201