Prognostic subdivision of pT2 rectal carcinomas
- 100 Downloads
The aim of the present study is to explore the prognostic impact of a subdivision of pT2 by the depth of invasion into the muscularis propria in rectal carcinomas.
Data from 269 consecutive patients with rectal carcinoma treated with primary tumor resection and lymph node dissection between 1986 and 2012 were analyzed with respect to locoregional and distant recurrence, disease-free survival, and overall survival. The depth of invasion into the muscularis propria of pT2 carcinomas was categorized by the pathologist into two groups: pT2a, invasion into the inner half of the muscularis propria; pT2b, invasion into the outer half of the muscularis propria.
One hundred nineteen of the 269 patients (44.2%) were classified pT2a and 150 patients (55.8%) were classified pT2b. In univariate analysis, significant differences between pT2a and pT2b carcinomas were found for locoregional recurrences (5-year rates 5.3 vs 14.0%; p = 0.025), distant metastases (14.1 vs 18.7%; p = 0.026), disease-free survival (78.2 vs 62.5%; p = 0.022), and overall survival (87.4 vs 72.5%; p = 0.013). In multivariate Cox regression analysis, the pT2 subdivision was found to be an independent risk factor for locoregional recurrence (hazard ratio 2.6; p = 0.023), disease-free survival (HR 1.4; p = 0.022), and overall survival (HR 1.5; p = 0.020), but only marginally for distant metastasis (HR 1.7; p = 0.083). Other independent prognostic factors were lymph node status, lymphatic invasion, and grading.
The depth of invasion into the muscularis propria is an independent prognostic factor for pT2 rectal carcinomas that will support decision-making for preoperative, surgical, and postoperative treatment.
KeywordsRectal carcinoma pT2 pT2 subdivision Prognosis Prognostic factor
We thank Prof. Dr. Paul Hermanek who originally had the idea for this study and PD Dr. Annelore Altendorf-Hofmann for the data collection before 1995.
Compliance with ethical standards
According to the ethics committee, written consent was not necessary for this retrospective analysis. All clinical data were analyzed anonymously.
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Brierly JD, Gospodarowicz MK, Wittekind C (eds) (2017) TNM classification of malignant tumours, 8th edn. Wiley Blackwell, OxfordGoogle Scholar
- 3.UICC (2001) In: Wittekind C, Henson DE, RVP H, Sobin LH (eds) TNM Supplement 2001. A commentary on uniform use, 2nd edn, Wiley & Sons, New YorkGoogle Scholar
- 4.UICC (2003) In: Wittekind C, Greene R, Henson DE, RVP H, Sobin LH (eds) TNM Supplement 2003. A commentary on uniform use, 3rd edn, Wiley & Sons, New YorkGoogle Scholar
- 5.UICC (2012) In: Wittekind CH, Compton CC, Brierley J, Sobin LH (eds) TNM supplement. A commentary on uniform use, 4th edn, Wiley-Blackwell, New YorkGoogle Scholar
- 9.Loughrey M, Quirke P, Shepherd N, Coordinators, The Royal College of Pathologists (2018) Loughrey M, Quirke P, Shepherd N, Coordinators, The Royal College of Pathologists. Dataset for colorectal cancer histopathology reports, 4th ed. https://www.rcpath.org/resourceLibrary/g049-dataset-for-histopathological-reporting-of-colorectal-cancer.html. Accessed 17 Oct 2018
- 10.Greenwood M (1926) The errors of sampling of the survivorship table reports on public health and medical subjects, vol 33. Her Majesty’s Stationery Office, LondonGoogle Scholar
- 11.Hohenberger W, Merkel S, Matzel K, Bittorf B, Papadopoulos T, Gohl J (2006) The influence of abdomino-peranal (intersphincteric) resection of lower third rectal carcinoma on the rates of sphincter preservation and locoregional recurrence. Colorectal Dis 8(1):23–33. https://doi.org/10.1111/j.1463-1318.2005.00839.x CrossRefGoogle Scholar
- 15.Al-Sukhni E, Milot L, Fruitman M, Beyene J, Victor JC, Schmocker S, Brown G, McLeod R, Kennedy E (2012) Diagnostic accuracy of MRI for assessment of T category, lymph node metastases, and circumferential resection margin involvement in patients with rectal cancer: a systematic review and meta-analysis. Ann Surg Oncol 19(7):2212–2223. https://doi.org/10.1245/s10434-011-2210-5 CrossRefGoogle Scholar
- 16.Taylor FG, Quirke P, Heald RJ, Moran BJ, Blomqvist L, Swift IR, Sebag-Montefiore D, Tekkis P, Brown G, Magnetic Resonance Imaging in Rectal Cancer European Equivalence Study Group (2014) Preoperative magnetic resonance imaging assessment of circumferential resection margin predicts disease-free survival and local recurrence: 5-year follow-up results of the MERCURY study. J Clin Oncol 32(1):34–43. https://doi.org/10.1200/JCO.2012.45.3258 CrossRefGoogle Scholar
- 17.Ruppert R, Junginger T, Ptok H, Strassburg J, Maurer CA, Brosi P, Sauer J, Baral J, Kreis M, Wollschlaeger D, Hermanek P, Merkel S, Ocum group (2018) Oncological outcome after MRI-based selection for neoadjuvant chemoradiotherapy in the OCUM rectal cancer trial. Br J Surg 105(11):1519–1529. https://doi.org/10.1002/bjs.10879 CrossRefGoogle Scholar