Marcel den Dulk1, Hein Putter2, Laurence Collette3, Corrie A M Marijnen4, Joakim Folkesson5, Jean-Francois Bosset6, Claus Rödel7, Krzysztof Bujko8, Lars Påhlman5, Cornelis J H van de Velde9. 1. Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. 2. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Statistics, EORTC Headquarters, Brussels, Belgium. 4. Department of Radiotherapy, NKI-AVL, Amsterdam, The Netherlands. 5. Department of Surgery, Uppsala University Hospital, Uppsala, Sweden. 6. Department of Radiation Therapy, Besançon University Hospital, Besançon, France. 7. Department of Radiation Therapy, University of Frankfurt, Frankfurt am Main, Germany. 8. Department of Radiotherapy, The Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland. 9. Department of Surgery, Leiden University Medical Center, K6-R, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Electronic address: c.j.h.van_de_velde@lumc.nl.
Abstract
PURPOSE: The aim of this study is to identify factors associated with the decision to perform an abdominoperineal resection (APR) and to assess if these factors or the surgical procedure itself is associated with circumferential resection margin (CRM) involvement, local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS). PATIENTS AND METHODS: The Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated, which indicated the predicted probability of undergoing an APR given gender, age and distance, and used in the multivariate analyses. RESULTS: An APR procedure was associated with an increased risk of CRM involvement [odd ratio (OR) 2.52, p<0.001], increased LR rate [hazard ratio (HR) 1.53, p=0.001] and decreased CSS rate (HR 1.31, p=0.002), whereas the propensity score was not. CONCLUSION: The results suggest that the APR procedure itself is a significant predictor for non-radical resections and increased risk of LR and death due to cancer for patients with advanced rectal cancer.
RCT Entities:
PURPOSE: The aim of this study is to identify factors associated with the decision to perform an abdominoperineal resection (APR) and to assess if these factors or the surgical procedure itself is associated with circumferential resection margin (CRM) involvement, local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS). PATIENTS AND METHODS: The Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated, which indicated the predicted probability of undergoing an APR given gender, age and distance, and used in the multivariate analyses. RESULTS: An APR procedure was associated with an increased risk of CRM involvement [odd ratio (OR) 2.52, p<0.001], increased LR rate [hazard ratio (HR) 1.53, p=0.001] and decreased CSS rate (HR 1.31, p=0.002), whereas the propensity score was not. CONCLUSION: The results suggest that the APR procedure itself is a significant predictor for non-radical resections and increased risk of LR and death due to cancer for patients with advanced rectal cancer.
Authors: Alejandro Rojo; Pilar Sancho; Oscar Alonso; Sara Encinas; Gemma Toledo; Juan F García Journal: Clin Transl Oncol Date: 2010-06 Impact factor: 3.405
Authors: M Kornmann; L Staib; T Wiegel; E-D Kreuser; M Kron; W Baumann; D Henne-Bruns; K-H Link Journal: Br J Cancer Date: 2010-09-28 Impact factor: 7.640