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Prognostic Groups in 1,676 Patients with T3 Rectal Cancer Treated without Preoperative Radiotherapy

  • Published:
Diseases of the Colon & Rectum

Purpose

The use of preoperative radiotherapy in patients with T3 tumors shows considerable variation among countries and institutions. The Norwegian guidelines have been very restrictive, limiting the indication to T4. This study was designed to identify subgroups of patients with T3 tumors with presumed high risks on adverse outcome and to use these results to reevaluate the national guidelines for preoperative radiotherapy.

Methods

This was a national cohort study of 2,460 patients with pT3 rectal adenocarcinoma, undergoing major surgery without preoperative radiotherapy from November 1993 to December 2002. Circumferential resection margin in millimeters was given for 1,676 patients.

Results

Multivariate analyses identified circumferential resection margin and nodal status as independent prognostic factors for local recurrence, metastases, and overall mortality. Analyses based on 12 combinations of N stage and circumferential resection margin showed that the estimated five-year rate of local recurrence increased from 11.1 percent (circumferential resection margin >3 mm; N0) to 36.5 percent (circumferential resection margin ≤1 mm; N2). The rate of distant metastases increased from 18.5 to 77.7 percent and the five-year survival decreased from 68.6 to 25.7 percent, respectively.

Conclusions

There is great variation in outcome for patients with T3 cancers, and the outcome is not acceptable for the groups of patients with circumferential resection margin <3 mm or involved lymph nodes. These groups should be considered for neoadjuvant therapy.

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Acknowledgments

The authors thank all Norwegian surgeons and pathologists who have contributed to the data collection.

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Authors and Affiliations

  1. Department of Surgery, Buskerud Hospital, N-3004, Drammen, Norway

    Morten T. Eriksen M.D. & Jon Haffner M.D., Ph.D.

  2. Cancer Registry of Norway, Oslo, Norway

    Morten T. Eriksen M.D.

  3. Department of Surgery, St. Olavs Hospital, Trondheim, Norway

    Arne Wibe M.D., Ph.D.

  4. Department of Surgery, The Norwegian Radium Hospital, Oslo, Norway

    Johan N. Wiig M.D., Ph.D.

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  1. Morten T. Eriksen M.D.
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  2. Arne Wibe M.D., Ph.D.
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  3. Jon Haffner M.D., Ph.D.
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  4. Johan N. Wiig M.D., Ph.D.
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on behalf of The Norwegian Rectal Cancer Group

Corresponding author

Correspondence to Morten T. Eriksen M.D..

Additional information

Supported by a grant from The Norwegian Foundation for Health and Rehabilitation.

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Eriksen, M.T., Wibe, A., Haffner, J. et al. Prognostic Groups in 1,676 Patients with T3 Rectal Cancer Treated without Preoperative Radiotherapy. Dis Colon Rectum 50, 156–167 (2007). https://doi.org/10.1007/s10350-006-0757-1

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