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Does the depth of mesorectal invasion have prognostic significance in patients with ypT3 lower rectal cancer treated with preoperative chemoradiotherapy?

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Abstract

Purpose

The prognostic significance of the depth of mesorectal invasion (DMI) in patients with ypT3 rectal cancer who undergo preoperative chemoradiotherapy (CRT) is unclear. The purpose of this study was to evaluate the prognostic significance of DMI in ypT3 rectal cancer.

Methods

A total of 168 (y)pT3 patients were evaluated, of whom 93 received preoperative CRT and 75 underwent surgery alone. Patients were subdivided into two groups according to the DMI (T3ab = DMI ≤5 mm and T3cd = DMI >5 mm). Oncologic outcomes were compared between the T3ab and T3cd groups and the ypT3ab and ypT3cd groups.

Results

Relapse-free survival was significantly different between the pT3ab and pT3cd groups (74.1 vs 38.5%, P = 0.0192) but not between the ypT3ab and ypT3cd groups (65.9 vs 61.5%, P = 0.513). Multivariate analysis showed that DMI was an independent predictor of recurrence in pT3 patients (hazard ratio [HR] = 2.980, 95% confidence interval [CI] 1.227–7.025; P = 0.0169) and that ypN+ was an independent predictor of recurrence in ypT3 patients (HR = 3.487, 95% CI 1.570–8.827; P = 0.0016).

Conclusions

DMI was not a significant predictive factor for recurrence in patients with ypT3 rectal cancer who underwent preoperative CRT, and ypN+ was the only independent predictive factor for recurrence.

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References

  1. Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P (2001) The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Color Dis 16:298–304

  2. Akagi Y, Shirouzu K, Fujita S, Ueno H, Takii Y, Komori K, Ito M, Sugihara K, Study Group of the Japanese Society for Cancer of the Colon and Rectum (JSCCR) on the Clinical Significance of the Mesorectal Extension of Rectal Cancer (2012) Predicting oncologic outcomes by stratifying mesorectal extension in patients with pT3 rectal cancer: a Japanese multi-institutional study. Int J Cancer 131:1220–1227

    Article  CAS  PubMed  Google Scholar 

  3. Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H, Talbot IC (2006) Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg 243:492–498

    Article  PubMed  PubMed Central  Google Scholar 

  4. Shirouzu K, Akagi Y, Fujita S, Ueno H, Takii Y, Komori K, Ito M, Sugihara K, Japanese Society for Cancer of the Colon and Rectum (JSCCR) on Clinical Significance of the Mesorectal Extension of Rectal Cancer (2011) Clinical significance of the mesorectal extension of rectal cancer: a Japanese multi-institutional study. Ann Surg 253:704–710

    Article  PubMed  Google Scholar 

  5. Glimelius B, Tiret E, Cervantes A, Arnold D, ESMO Gudelines Working Group (2013) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi81–vi88

    Article  PubMed  Google Scholar 

  6. Merkel S, Weber K, Schellerer V, Gohl J, Fietkau R, Agaimy A, Hohenberger W, Hermanek P (2014) Prognostic subdivision of ypT3 rectal tumours according to extension beyond the muscularis propria. Br J Surg 101:566–572

    Article  CAS  PubMed  Google Scholar 

  7. Shin R, Jeong SY, Yoo HY, Park KJ, Heo SC, Kang GH, Kim WH, Park JG (2012) Depth of mesorectal extension has prognostic significance in patients with T3 rectal cancer. Dis Colon Rectum 55:1220–1228

    Article  PubMed  Google Scholar 

  8. Bori R, Sejben I, Svebis M, Vajda K, Marko L, Pajkos G, Cserni G (2009) Heterogeneity of pT3 colorectal carcinomas according to the depth of invasion. Pathol Oncol Res 15:527–532

    Article  CAS  PubMed  Google Scholar 

  9. Taylor FG, Quirke P, Heald RJ, Moran B, Blomqvist L, Swift I, Sebag-Montefiore DJ, Tekkis P, Brown G, MERCURY study group (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 253:711–719

    Article  PubMed  Google Scholar 

  10. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26:303–312

    Article  PubMed  Google Scholar 

  11. Gosens MJ, Klaassen RA, Tan-Go I, Rutten HJ, Martijn H, van den Brule AJ, Nieuwenhuijzen GA, van Krieken JH, Nagtegaal ID (2007) Circumferential margin involvement is the crucial prognostic factor after multimodality treatment in patients with locally advanced rectal carcinoma. Clin Cancer Res 13:6617–6623

    Article  CAS  PubMed  Google Scholar 

  12. Park JS, Huh JW, Park YA, Cho YB, Yun SH, Kim HC, Lee WY, Chun HK (2014) A circumferential resection margin of 1 mm is a negative prognostic factor in rectal cancer patients with and without neoadjuvant chemoradiotherapy. Dis Colon Rectum 57:933–940

    Article  PubMed  Google Scholar 

  13. Moon SH, Kim DY, Park JW, Oh JH, Chang HJ, Kim SY, Kim TH, Park HC, Choi DH, Chun HK, Kim JH, Park JH, Yu CS (2012) Can the new American Joint Committee on Cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy? Cancer 118:4961–4968

    Article  PubMed  Google Scholar 

  14. Lindebjerg J, Spindler KL, Ploen J, Jakobsen A (2009) The prognostic value of lymph node metastases and tumour regression grade in rectal cancer patients treated with long-course preoperative chemoradiotherapy. Color Dis 11:264–269

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Atsushi Ogura, Takashi Akiyoshi, Yosuke Fukunaga & Masashi Ueno

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Atsushi Ogura & Masato Nagino

  3. Division of Pathology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan

    Noriko Yamamoto, Hiroshi Kawachi & Yuichi Ishikawa

  4. Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Hisashi Noma

Authors
  1. Atsushi Ogura
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  2. Takashi Akiyoshi
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  3. Noriko Yamamoto
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  4. Hiroshi Kawachi
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  5. Yuichi Ishikawa
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  6. Hisashi Noma
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  7. Masato Nagino
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  8. Yosuke Fukunaga
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  9. Masashi Ueno
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Correspondence to Takashi Akiyoshi.

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Ogura, A., Akiyoshi, T., Yamamoto, N. et al. Does the depth of mesorectal invasion have prognostic significance in patients with ypT3 lower rectal cancer treated with preoperative chemoradiotherapy?. Int J Colorectal Dis 32, 349–356 (2017). https://doi.org/10.1007/s00384-016-2716-1

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  • DOI: https://doi.org/10.1007/s00384-016-2716-1

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