What Prognostic Clinical Factors Must Be Considered Before Treatment?

  • Claus Rödel


Pretreatment prognostic factors comprise both patient- and tumor-related characteristics. Female sex has been shown to be associated with a more favorable survival; however, it is unlikely that there are gender-specific differences in rectal cancer-specific survival rates. Higher rates of toxicity and treatment deviation have been noted among elderly patients. An increased body mass index was associated with a decreased likelihood of sphincter preservation and an increased risk of local recurrences. Tumor-related risk factors include circumferential, tethered or fixed, obstructing, and low-lying tumors. The cT- and cN-stage are associated with the risk of failure; however, they do not separate different prognostic groups equally effective compared with the ypT- and ypN-stage. MRI-defined risk factors comprise the spread of the tumor into the mesorectal compartment, the distance of the tumor to the mesorectal fascia, and the identification of extramural venous invasion.


Rectal Cancer Anal Verge Circumferential Resection Margin Dutch Trial Mesorectal Fascia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Valentini V, van Stiphout RG, Lammering G et al (2011) Nomograms for predicting local recurrence, distant metastases, and overall survival for patients with locally advanced rectal cancer on the basis of European randomized clinical trials. J Clin Oncol 29:3163–3172PubMedCrossRefGoogle Scholar
  2. 2.
    Rutten HJ, den Dulk M, Lemmens VE et al (2008) Controversies of total mesorectal excision for rectal cancer in elderly patients. Lancet Oncol 9:494–501PubMedCrossRefGoogle Scholar
  3. 3.
    Tepper JE, O’Connell M, Niedzwiecki D et al (2002) Adjuvant therapy in rectal cancer: analysis of stage, sex, and local control – final report of intergroup 0114. J Clin Oncol 20:1744–1750PubMedCrossRefGoogle Scholar
  4. 4.
    van Gijn W, Marijnen CA, Nagtegaal ID et al (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12:575–582PubMedCrossRefGoogle Scholar
  5. 5.
    Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373:811–820PubMedCrossRefGoogle Scholar
  6. 6.
    Birgisson H, Pahlman L, Gunnarsson U et al (2005) Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish rectal cancer trial. J Clin Oncol 23:8697–8705PubMedCrossRefGoogle Scholar
  7. 7.
    Valentini V, Beets-Tan R, Borras JM et al (2008) Evidence and research in rectal cancer. Radiother Oncol 87:449–474PubMedCrossRefGoogle Scholar
  8. 8.
    Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740PubMedCrossRefGoogle Scholar
  9. 9.
    MERCURY Study Group (2007) Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer: results of the MERCURY study. Radiology 243:132–139CrossRefGoogle Scholar
  10. 10.
    Kim CW, Yu CS, Yang SS et al (2011) Clinical significance of Pre- to post-chemoradiotherapy s-CEA reduction ratio in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection. Ann Surg Oncol 18:3271–3277PubMedCrossRefGoogle Scholar
  11. 11.
    Lee SD, Park JW, Park KS et al (2009) Influence of anemia on tumor response to preoperative chemoradiotherapy for locally advanced rectal cancer. Int J Colorectal Dis 24:1451–1458PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Radiotherapy and OncologyJohann Wolfgang Goethe-University FrankfurtFrankfurt am MainGermany

Personalised recommendations