Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer

Won Sup Yoon, Won Park, Doo Ho Choi, Yong Chan Ahn, Ho Kyung Chun, Woo Yong Lee, Seong Hyeon Yun, Won Ki Kang, Ho Yeong Lim, Young Suk Park

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims and background. To evaluate the clinical factors that influence pathological and clinical outcomes after preoperative concurrent chemoradiotherapy in patients with rectal cancer. Methods. Between 1999 and 2004, 121 patients with cT3-4 or node-positive rectal cancer received preoperative chemoradiotherapy and surgery. Preoperative radiation therapy with 45 Gy was delivered. Fluorouracil-based chemotherapy was administered to most of the patients. Results. Pathological complete remission was 14.3% after preoperative chemoradiotherapy. More than 60% tumor circumferential extent was an independent adverse factor for complete remission (P = 0.011, HR 4.643, 95% CI 1.415-15.231). Local recurrence developed in 9.9% of the cases. Serum CEA level ≥5 ng/ml (P = 0.057, HR 3.022, 95% CI 0.967-9.441) and >60% circumferential extent of tumor (P = 0.064, HR 4.232, 95% CI 0.918-19.531) were marginal adverse factors for local recurrence. Five-year disease-free survival and overall survival were 72.2%and 86.6%, respectively. Diseasefree survival was poor for patients with the lymph nodes ≥1 cm in diameter (P = 0.028), cN2 stage disease (P = 0.047) and >60% circumferential extent of tumor (P = 0.058). Multivariate analysis for disease-free survival showed that the lymph node size ≥1 cm was an adverse factor (P = 0.019, HR 2.380, 95% CI 1.115-4.906). Patients with >60% circumferential extent of tumor and cN2 stage had amore unfavorable survival than the other patients (disease-free survival, P = 0.018; overall survival, P = 0.015). Patients with >60% circumferential extent of tumor and/or lymph node ≥1 cm also had an unfavorable survival (disease-free survival, P = 0.016; overall survival, P = 0.049). Conclusions. In rectal cancer, circumferential extent of tumor and clinical lymph node status were important factors for preoperative chemoradiotherapy and surgery. A further prospective study is needed to confirm and expand these findings.

Original languageEnglish
Pages (from-to)568-576
Number of pages9
JournalTumori
Volume96
Issue number4
Publication statusPublished - 2010 Jan 1

Fingerprint

Chemoradiotherapy
Rectal Neoplasms
Lymph Nodes
Disease-Free Survival
Survival
Neoplasms
Recurrence
Fluorouracil
Radiotherapy
Multivariate Analysis
Prospective Studies
Drug Therapy
Serum

Keywords

  • Circumferential extent
  • Lymph nodes
  • Preoperative chemoradiotherapy
  • Prognostic factors
  • Rectal cancer

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer. / Yoon, Won Sup; Park, Won; Choi, Doo Ho; Ahn, Yong Chan; Chun, Ho Kyung; Lee, Woo Yong; Yun, Seong Hyeon; Kang, Won Ki; Lim, Ho Yeong; Park, Young Suk.

In: Tumori, Vol. 96, No. 4, 01.01.2010, p. 568-576.

Research output: Contribution to journalArticle

Yoon, Won Sup ; Park, Won ; Choi, Doo Ho ; Ahn, Yong Chan ; Chun, Ho Kyung ; Lee, Woo Yong ; Yun, Seong Hyeon ; Kang, Won Ki ; Lim, Ho Yeong ; Park, Young Suk. / Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer. In: Tumori. 2010 ; Vol. 96, No. 4. pp. 568-576.
@article{5e2ecfd607f14858887d0ba0f0cb32ba,
title = "Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer",
abstract = "Aims and background. To evaluate the clinical factors that influence pathological and clinical outcomes after preoperative concurrent chemoradiotherapy in patients with rectal cancer. Methods. Between 1999 and 2004, 121 patients with cT3-4 or node-positive rectal cancer received preoperative chemoradiotherapy and surgery. Preoperative radiation therapy with 45 Gy was delivered. Fluorouracil-based chemotherapy was administered to most of the patients. Results. Pathological complete remission was 14.3{\%} after preoperative chemoradiotherapy. More than 60{\%} tumor circumferential extent was an independent adverse factor for complete remission (P = 0.011, HR 4.643, 95{\%} CI 1.415-15.231). Local recurrence developed in 9.9{\%} of the cases. Serum CEA level ≥5 ng/ml (P = 0.057, HR 3.022, 95{\%} CI 0.967-9.441) and >60{\%} circumferential extent of tumor (P = 0.064, HR 4.232, 95{\%} CI 0.918-19.531) were marginal adverse factors for local recurrence. Five-year disease-free survival and overall survival were 72.2{\%}and 86.6{\%}, respectively. Diseasefree survival was poor for patients with the lymph nodes ≥1 cm in diameter (P = 0.028), cN2 stage disease (P = 0.047) and >60{\%} circumferential extent of tumor (P = 0.058). Multivariate analysis for disease-free survival showed that the lymph node size ≥1 cm was an adverse factor (P = 0.019, HR 2.380, 95{\%} CI 1.115-4.906). Patients with >60{\%} circumferential extent of tumor and cN2 stage had amore unfavorable survival than the other patients (disease-free survival, P = 0.018; overall survival, P = 0.015). Patients with >60{\%} circumferential extent of tumor and/or lymph node ≥1 cm also had an unfavorable survival (disease-free survival, P = 0.016; overall survival, P = 0.049). Conclusions. In rectal cancer, circumferential extent of tumor and clinical lymph node status were important factors for preoperative chemoradiotherapy and surgery. A further prospective study is needed to confirm and expand these findings.",
keywords = "Circumferential extent, Lymph nodes, Preoperative chemoradiotherapy, Prognostic factors, Rectal cancer",
author = "Yoon, {Won Sup} and Won Park and Choi, {Doo Ho} and Ahn, {Yong Chan} and Chun, {Ho Kyung} and Lee, {Woo Yong} and Yun, {Seong Hyeon} and Kang, {Won Ki} and Lim, {Ho Yeong} and Park, {Young Suk}",
year = "2010",
month = "1",
day = "1",
language = "English",
volume = "96",
pages = "568--576",
journal = "Tumori",
issn = "0300-8916",
publisher = "Wichtig Publishing",
number = "4",

}

TY - JOUR

T1 - Importance of the circumferential extent of tumors and clinical lymph node status as prognostic factors after preoperative chemoradiotherapy and surgery in patients with rectal cancer

AU - Yoon, Won Sup

AU - Park, Won

AU - Choi, Doo Ho

AU - Ahn, Yong Chan

AU - Chun, Ho Kyung

AU - Lee, Woo Yong

AU - Yun, Seong Hyeon

AU - Kang, Won Ki

AU - Lim, Ho Yeong

AU - Park, Young Suk

PY - 2010/1/1

Y1 - 2010/1/1

N2 - Aims and background. To evaluate the clinical factors that influence pathological and clinical outcomes after preoperative concurrent chemoradiotherapy in patients with rectal cancer. Methods. Between 1999 and 2004, 121 patients with cT3-4 or node-positive rectal cancer received preoperative chemoradiotherapy and surgery. Preoperative radiation therapy with 45 Gy was delivered. Fluorouracil-based chemotherapy was administered to most of the patients. Results. Pathological complete remission was 14.3% after preoperative chemoradiotherapy. More than 60% tumor circumferential extent was an independent adverse factor for complete remission (P = 0.011, HR 4.643, 95% CI 1.415-15.231). Local recurrence developed in 9.9% of the cases. Serum CEA level ≥5 ng/ml (P = 0.057, HR 3.022, 95% CI 0.967-9.441) and >60% circumferential extent of tumor (P = 0.064, HR 4.232, 95% CI 0.918-19.531) were marginal adverse factors for local recurrence. Five-year disease-free survival and overall survival were 72.2%and 86.6%, respectively. Diseasefree survival was poor for patients with the lymph nodes ≥1 cm in diameter (P = 0.028), cN2 stage disease (P = 0.047) and >60% circumferential extent of tumor (P = 0.058). Multivariate analysis for disease-free survival showed that the lymph node size ≥1 cm was an adverse factor (P = 0.019, HR 2.380, 95% CI 1.115-4.906). Patients with >60% circumferential extent of tumor and cN2 stage had amore unfavorable survival than the other patients (disease-free survival, P = 0.018; overall survival, P = 0.015). Patients with >60% circumferential extent of tumor and/or lymph node ≥1 cm also had an unfavorable survival (disease-free survival, P = 0.016; overall survival, P = 0.049). Conclusions. In rectal cancer, circumferential extent of tumor and clinical lymph node status were important factors for preoperative chemoradiotherapy and surgery. A further prospective study is needed to confirm and expand these findings.

AB - Aims and background. To evaluate the clinical factors that influence pathological and clinical outcomes after preoperative concurrent chemoradiotherapy in patients with rectal cancer. Methods. Between 1999 and 2004, 121 patients with cT3-4 or node-positive rectal cancer received preoperative chemoradiotherapy and surgery. Preoperative radiation therapy with 45 Gy was delivered. Fluorouracil-based chemotherapy was administered to most of the patients. Results. Pathological complete remission was 14.3% after preoperative chemoradiotherapy. More than 60% tumor circumferential extent was an independent adverse factor for complete remission (P = 0.011, HR 4.643, 95% CI 1.415-15.231). Local recurrence developed in 9.9% of the cases. Serum CEA level ≥5 ng/ml (P = 0.057, HR 3.022, 95% CI 0.967-9.441) and >60% circumferential extent of tumor (P = 0.064, HR 4.232, 95% CI 0.918-19.531) were marginal adverse factors for local recurrence. Five-year disease-free survival and overall survival were 72.2%and 86.6%, respectively. Diseasefree survival was poor for patients with the lymph nodes ≥1 cm in diameter (P = 0.028), cN2 stage disease (P = 0.047) and >60% circumferential extent of tumor (P = 0.058). Multivariate analysis for disease-free survival showed that the lymph node size ≥1 cm was an adverse factor (P = 0.019, HR 2.380, 95% CI 1.115-4.906). Patients with >60% circumferential extent of tumor and cN2 stage had amore unfavorable survival than the other patients (disease-free survival, P = 0.018; overall survival, P = 0.015). Patients with >60% circumferential extent of tumor and/or lymph node ≥1 cm also had an unfavorable survival (disease-free survival, P = 0.016; overall survival, P = 0.049). Conclusions. In rectal cancer, circumferential extent of tumor and clinical lymph node status were important factors for preoperative chemoradiotherapy and surgery. A further prospective study is needed to confirm and expand these findings.

KW - Circumferential extent

KW - Lymph nodes

KW - Preoperative chemoradiotherapy

KW - Prognostic factors

KW - Rectal cancer

UR - http://www.scopus.com/inward/record.url?scp=77957193986&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957193986&partnerID=8YFLogxK

M3 - Article

VL - 96

SP - 568

EP - 576

JO - Tumori

JF - Tumori

SN - 0300-8916

IS - 4

ER -