Fan Li1,2, Jin-Hai Chen3, Yang Liu4, Guo-Xian Guan5, Chuan-Hui Lu1,2. 1. Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. 2. The Third Clinical Medical College, Fujian Medical University, Fuzhou, China. 3. Department of Endoscopy Center, The First Affiliated Hospital of Xiamen University, Xiamen, China. 4. Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, China. 5. Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Abstract
Background: Whether all cT3 low rectal cancer patients should receive neoadjuvant chemoradiotherapy (nCRT) remains controversial. The depth of invasion beyond the muscularis propria of the cT3 rectal cancer is of great significance to the selection of a treatment plan and the evaluation of prognosis. Methods: A retrospective analysis was conducted of 187 patients with stage cT3 low rectal cancer, who had been treated at the Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University from June 2010 to December 2012. The patients were divided into the nCRT group (88 cases) and no-nCRT group (99 cases). Possible significant prognostic factors [i.e., primary tumor volume (PTV), cell differentiation, circumferential resection margin (CRM), nCRT, age, sex, carcinoembryonic antigen (CEA), lymph node status, surgical procedure, etc.] were collected for estimation of disease-free survival (DFS), distant metastases rate (DM), local recurrence rate (LR). Independent predictive factors or survival were determined using Cox proportional hazards model. Results: The mean PTV was 16.2±11.1 (2.07-72.68) cm3. In the univariate and multivariate analyses: nCRT hazards ratio (HR) =4.258, 95% confidence interval (CI): 1.912-9.483 (P<0.001); PTV HR =0.381, 95% CI: 0.181-0.804 (P=0.011); CRM HR =0.227, 95% CI: 0.097-0.532 (P=0.001). For the PTV ≤15 cm3 group, there were no significant differences between the nCRT and no-nCRT group in 3-year follow-up (P>0.05). For the PTV >15 cm3 group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (84.2% vs. 51.1%; P=0.001), DM (13.1% vs. 31.2%; P=0.017) and LR (2.9% vs. 26.6%; P=0.009). For the CRM negative group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (94.0% vs. 79.0%; P=0.008), LR (1.5% vs. 10.7%; P=0.028) and DM (4.5% vs. 13.5%; P=0.039). Conclusions: For stage cT3 low rectal cancer patients, nCRT, PTV, and CRM were independent prognostic factors. NCRT may improve the survival of PTV >15 cm3 patients, but may not have a significant effect on patient with PTV ≤15 cm3 and CRM negative. Direct surgery is recommended for this group of patients. 2022 Journal of Gastrointestinal Oncology. All rights reserved.
Background: Whether all cT3 low rectal cancer patients should receive neoadjuvant chemoradiotherapy (nCRT) remains controversial. The depth of invasion beyond the muscularis propria of the cT3 rectal cancer is of great significance to the selection of a treatment plan and the evaluation of prognosis. Methods: A retrospective analysis was conducted of 187 patients with stage cT3 low rectal cancer, who had been treated at the Department of Colorectal Surgery, The First Affiliated Hospital of Xiamen University from June 2010 to December 2012. The patients were divided into the nCRT group (88 cases) and no-nCRT group (99 cases). Possible significant prognostic factors [i.e., primary tumor volume (PTV), cell differentiation, circumferential resection margin (CRM), nCRT, age, sex, carcinoembryonic antigen (CEA), lymph node status, surgical procedure, etc.] were collected for estimation of disease-free survival (DFS), distant metastases rate (DM), local recurrence rate (LR). Independent predictive factors or survival were determined using Cox proportional hazards model. Results: The mean PTV was 16.2±11.1 (2.07-72.68) cm3. In the univariate and multivariate analyses: nCRT hazards ratio (HR) =4.258, 95% confidence interval (CI): 1.912-9.483 (P<0.001); PTV HR =0.381, 95% CI: 0.181-0.804 (P=0.011); CRM HR =0.227, 95% CI: 0.097-0.532 (P=0.001). For the PTV ≤15 cm3 group, there were no significant differences between the nCRT and no-nCRT group in 3-year follow-up (P>0.05). For the PTV >15 cm3 group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (84.2% vs. 51.1%; P=0.001), DM (13.1% vs. 31.2%; P=0.017) and LR (2.9% vs. 26.6%; P=0.009). For the CRM negative group, there were significant differences between the nCRT and no-nCRT group in 3-year DFS (94.0% vs. 79.0%; P=0.008), LR (1.5% vs. 10.7%; P=0.028) and DM (4.5% vs. 13.5%; P=0.039). Conclusions: For stage cT3 low rectal cancer patients, nCRT, PTV, and CRM were independent prognostic factors. NCRT may improve the survival of PTV >15 cm3 patients, but may not have a significant effect on patient with PTV ≤15 cm3 and CRM negative. Direct surgery is recommended for this group of patients. 2022 Journal of Gastrointestinal Oncology. All rights reserved.
Authors: Mahul B Amin; Frederick L Greene; Stephen B Edge; Carolyn C Compton; Jeffrey E Gershenwald; Robert K Brookland; Laura Meyer; Donna M Gress; David R Byrd; David P Winchester Journal: CA Cancer J Clin Date: 2017-01-17 Impact factor: 508.702
Authors: Al B Benson; Alan P Venook; Mahmoud M Al-Hawary; Mustafa A Arain; Yi-Jen Chen; Kristen K Ciombor; Stacey Cohen; Harry S Cooper; Dustin Deming; Ignacio Garrido-Laguna; Jean L Grem; Andrew Gunn; Sarah Hoffe; Joleen Hubbard; Steven Hunt; Natalie Kirilcuk; Smitha Krishnamurthi; Wells A Messersmith; Jeffrey Meyerhardt; Eric D Miller; Mary F Mulcahy; Steven Nurkin; Michael J Overman; Aparna Parikh; Hitendra Patel; Katrina Pedersen; Leonard Saltz; Charles Schneider; David Shibata; John M Skibber; Constantinos T Sofocleous; Elena M Stoffel; Eden Stotsky-Himelfarb; Christopher G Willett; Alyse Johnson-Chilla; Lisa A Gurski Journal: J Natl Compr Canc Netw Date: 2020-07 Impact factor: 11.908
Authors: D Genovesi; A Filippone; G Ausili Cèfaro; M Trignani; A Vinciguerra; A Augurio; M Di Tommaso; V Borzillo; F Sabatino; P Innocenti; E Liberatore; G Colecchia; A Tartaro; A R Cotroneo Journal: Eur J Surg Oncol Date: 2013-08-15 Impact factor: 4.424
Authors: H J Schmoll; E Van Cutsem; A Stein; V Valentini; B Glimelius; K Haustermans; B Nordlinger; C J van de Velde; J Balmana; J Regula; I D Nagtegaal; R G Beets-Tan; D Arnold; F Ciardiello; P Hoff; D Kerr; C H Köhne; R Labianca; T Price; W Scheithauer; A Sobrero; J Tabernero; D Aderka; S Barroso; G Bodoky; J Y Douillard; H El Ghazaly; J Gallardo; A Garin; R Glynne-Jones; K Jordan; A Meshcheryakov; D Papamichail; P Pfeiffer; I Souglakos; S Turhal; A Cervantes Journal: Ann Oncol Date: 2012-10 Impact factor: 32.976
Authors: Sanne M E Engelen; Regina G H Beets-Tan; Max J Lahaye; Guido Lammering; Rob L H Jansen; Ronald M van Dam; Joop Konsten; Jeroen W A Leijtens; Cornelis J H van de Velde; Geerard L Beets Journal: Dis Colon Rectum Date: 2010-07 Impact factor: 4.585
Authors: Nina A Mayr; Toshiaki Taoka; William T C Yuh; Leah M Denning; Weining K Zhen; Arnold C Paulino; Robert C Gaston; Joel I Sorosky; Sanford L Meeks; Joan L Walker; Robert S Mannel; John M Buatti Journal: Int J Radiat Oncol Biol Phys Date: 2002-01-01 Impact factor: 7.038
Authors: Esther M F Wong; Bill M H Lai; Vincent K P Fung; Hester Y S Cheung; W T Ng; Ada L Y Law; Alta Y T Lai; Jennifer L S Khoo Journal: Hong Kong Med J Date: 2014-08-01 Impact factor: 2.227
Authors: Yiftach Roth; Thomas Tichler; Genady Kostenich; Jesus Ruiz-Cabello; Stephan E Maier; Jack S Cohen; Arie Orenstein; Yael Mardor Journal: Radiology Date: 2004-06-23 Impact factor: 11.105