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Pathologic Determinants of Survival After Resection of T3N0 (Stage IIA) Colorectal Cancer: Proposal for a New Prognostic Model

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Diseases of the Colon & Rectum

Purpose

There is an increasing need for accurate prognostic stratification of patients with Stage II colorectal cancer to identify a subgroup of high-risk patients who may benefit from adjuvant therapies. This study was designed to evaluate the prognostic impact of a wide spectrum of pathologic parameters in a consecutive series of homogenously treated and well-characterized patients with Stage IIA (T3N0M0) colorectal cancer.

Methods

The study included 238 patients operated on by a single surgeon for Stage IIA colorectal tumors. The median postoperative follow-up was 110 (range, 96–120) months. At least 12 lymph nodes were harvested and examined in all the resection specimens. The prognostic value of 13 pathologic parameters, including lymph node occult disease (micrometastases) detected by immunohistochemistry, was investigated.

Results

Multivariate analysis identified tumor growth pattern (expanding or infiltrating; P = 0.01) and extent of tumor spread beyond muscularis propria (≤5 mm or >5 mm; P = 0.04) as the only factors having independent prognostic value. The combination of these two easily determined parameters allowed us to identify two groups of patients at low risk or high risk of tumor recurrence. The eight-year survival rates were 83.3 and 53.4 percent for the two groups, respectively. The high-risk group comprised those patients with infiltrating tumors and extramural tumor spread > 5 mm.

Conclusions

We propose a new and simple prognostic model to identify patients with high-risk Stage IIA colorectal cancer for whom adjuvant therapies may be justified and effective.

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References

  1. CE Dukes (1932) ArticleTitleThe classification of cancer of the rectum. J Pathol Bacteriol 35 323–332 Occurrence Handle10.1002/path.1700350303

    Article  Google Scholar 

  2. CC Compton LP Fielding LJ Burgart et al. (2000) ArticleTitlePrognostic factors in colorectal cancer: College of American Pathologists consensus statement 1999. Arch Pathol Lab Med 124 979–994 Occurrence Handle10888773 Occurrence Handle1:STN:280:DC%2BD3czptVKrug%3D%3D

    PubMed  CAS  Google Scholar 

  3. F Cianchi L Messerini A Palomba et al. (1997) ArticleTitleCharacter of the invasive margin in colorectal cancer: does it improve prognostic information of Dukes staging? Dis Colon Rectum 40 1170–1176 Occurrence Handle9336111 Occurrence Handle10.1007/BF02055162 Occurrence Handle1:STN:280:DyaK2svnsFylsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  4. VC Petersen KJ Baxter SB Love et al. (2002) ArticleTitleIdentification of objective pathological prognostic determinants and models of prognosis in Dukes’ B colon cancer. Gut 51 65–69 Occurrence Handle12077094 Occurrence Handle10.1136/gut.51.1.65 Occurrence Handle1:STN:280:DC%2BD38zjsVSjsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  5. F Cianchi A Palomba V Boddi et al. (2002) ArticleTitleLymph node recovery from colorectal tumor specimens: recommendation for a minimum number of lymph nodes to be examined. World J Surg 26 384–389 Occurrence Handle11865379 Occurrence Handle10.1007/s00268-001-0236-8

    Article  PubMed  Google Scholar 

  6. NA Shepherd KJ Baxter SB Love (1997) ArticleTitleThe prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation. Gastroenterology 112 1096–1102 Occurrence Handle9097991 Occurrence Handle10.1016/S0016-5085(97)70119-7 Occurrence Handle1:STN:280:DyaK2s3lt1ChsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  7. G Burdy Y Panis A Alves et al. (2001) ArticleTitleIdentifying patients with T3-T4 node-negative colon cancer at high risk of recurrence. Dis Colon Rectum 44 1682–1688 Occurrence Handle11711742 Occurrence Handle10.1007/BF02234390 Occurrence Handle1:STN:280:DC%2BD3MnmsFKgtg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  8. FL Greene DL Page ID Fleming et al. (2002) AJCC cancer staging manual EditionNumber6th ed. Springer-Verlag New York

    Google Scholar 

  9. JB O’Conell MA Maggard CY Ko (2004) ArticleTitleColon cancer survival rates with the new American Joint Committee on Cancer Sixth Edition Staging. J Natl Cancer Inst 96 1420–1425 Occurrence Handle10.1093/jnci/djh275

    Article  Google Scholar 

  10. A Öberg R Stenling B Tavelin et al. (1998) ArticleTitleAre lymph node micrometastases of any clinical significance in Dukes Stages A and B colorectal cancer? Dis Colon Rectum 41 1244–1249 Occurrence Handle9788387 Occurrence Handle10.1007/BF02258221

    Article  PubMed  Google Scholar 

  11. N Isaka M Nozue M Doy et al. (1999) ArticleTitlePrognostic significance of perirectal lymph node micrometastases in Dukes’ B rectal carcinoma: an immunohistochemical study by CAM5.2. Clin Cancer Res 5 2065–2068 Occurrence Handle10473087 Occurrence Handle1:STN:280:DyaK1MvgtVSltA%3D%3D

    PubMed  CAS  Google Scholar 

  12. J Tschmelitsch DS Klimstra AM Cohen (2000) ArticleTitleLymph node micrometastases do not predict relapse in Stage II colon cancer. Ann Surg Oncol 7 601–608 Occurrence Handle11005559 Occurrence Handle1:STN:280:DC%2BD3cvltVGktw%3D%3D

    PubMed  CAS  Google Scholar 

  13. S Andreola E Leo F Belli et al. (2001) ArticleTitleAdenocarcinoma of the lower third of the rectum: metastases in lymph nodes smaller than 5 mm and occult micrometastases; preliminary results on early tumor recurrence. Ann Surg Oncol 8 413–417 Occurrence Handle11407515 Occurrence Handle10.1007/s10434-001-0413-x Occurrence Handle1:STN:280:DC%2BD3MzksVGhtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  14. K Yasuda Y Adachi N Shiraishi et al. (2001) ArticleTitlePattern of lymph node micrometastasis and prognosis of patients with colorectal cancer. Ann Surg Oncol 8 300–304 Occurrence Handle11352302 Occurrence Handle10.1007/s10434-001-0300-5 Occurrence Handle1:STN:280:DC%2BD3M3lsVWgtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  15. RJ Feezor EM Copeland SN Hochwald (2002) ArticleTitleSignificance of micrometastases in colorectal cancer. Ann Surg Oncol 9 944–953 Occurrence Handle12464585 Occurrence Handle10.1007/BF02574511

    Article  PubMed  Google Scholar 

  16. U Kronberg F López-Kostner G Soto et al. (2004) ArticleTitleDetection of lymphatic micrometastasis in patients with Stages I and II colorectal cancer: impact on five-year survival. Dis Colon Rectum 47 1151–1157 Occurrence Handle15164250 Occurrence Handle10.1007/s10350-004-0560-9

    Article  PubMed  Google Scholar 

  17. P Hermanek RV Hutter LH Sobin C Wittekind (1999) ArticleTitleClassification of isolated tumor cells and micrometastases. Cancer 15 2668–2673 Occurrence Handle10.1002/(SICI)1097-0142(19991215)86:12<2668::AID-CNCR11>3.0.CO;2-R

    Article  Google Scholar 

  18. JR Jass S Love JM Northover (1987) ArticleTitleA new prognostic classification for rectal cancer. Lancet 1 1303–1306 Occurrence Handle2884421 Occurrence Handle10.1016/S0140-6736(87)90552-6 Occurrence Handle1:STN:280:DyaL2s3islOiug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  19. TB Halvorsen E Seim (1989) ArticleTitleAssociation between invasiveness, inflammatory reaction, desmoplasia and survival in colorectal cancer. J Clin Pathol 42 162–166 Occurrence Handle2921357 Occurrence Handle10.1136/jcp.42.2.162 Occurrence Handle1:STN:280:DyaL1M7lsFyluw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  20. JC Harrison PJ Dean F El-Zeky et al. (1994) ArticleTitleFrom Dukes through Jass: pathological prognostic indicators in rectal cancer. Hum Pathol 25 498–505 Occurrence Handle8200644 Occurrence Handle10.1016/0046-8177(94)90122-8 Occurrence Handle1:STN:280:DyaK2c3lvFChsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  21. IC Talbot S Ritchie M Leighton et al. (1981) ArticleTitleInvasion of veins by carcinoma of rectum: method of detection, histological features and significance. Histopathology 5 141–163 Occurrence Handle7216178 Occurrence Handle10.1111/j.1365-2559.1981.tb01774.x Occurrence Handle1:STN:280:DyaL3M7ms1artg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  22. C Compton CM Fenoglio-Preiser N Pettigrew LP Fielding (2000) ArticleTitleAmerican Joint Committee on Cancer Prognostic Factors Consensus Conference. Colorectal Working Group Cancer 88 1739–1757 Occurrence Handle10738234 Occurrence Handle10.1002/(SICI)1097-0142(20000401)88:7<1739::AID-CNCR30>3.0.CO;2-T Occurrence Handle1:STN:280:DC%2BD3c3gsVaiug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  23. E Kaplan P Meier (1958) ArticleTitleNon parametric estimation from incomplete observations. J Am Stat Assoc 53 457–481 Occurrence Handle10.2307/2281868

    Article  Google Scholar 

  24. DR Cox (1972) ArticleTitleRegression model and life tables. J R Stat Soc (B)34 187–220

    Google Scholar 

  25. InstitutionalAuthorNameAnonymous. (1995) ArticleTitleInternational Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT) investigators. Efficacy of adjuvant fluorouracil and folinic acid in colon cancer. Lancet 345 939–944 Occurrence Handle10.1016/S0140-6736(95)90696-7

    Article  Google Scholar 

  26. N Wolmark H Rockette B Fisher et al. (1993) ArticleTitleThe benefit of leucovorin-modulated fluorouracil as postoperative adjuvant therapy for primary colon cancer: results from National Surgical Adjuvant Breast and Bowel Project protocol C-03. J Clin Oncol 11 1879–1887 Occurrence Handle8410113 Occurrence Handle1:STN:280:DyaK2c%2FhsFajtw%3D%3D

    PubMed  CAS  Google Scholar 

  27. E Mamounas S Wieand N Wolmark et al. (1999) ArticleTitleComparative efficacy of adjuvant chemotherapy in patients with Dukes’ B versus Dukes’ C colon cancer: results from four national surgical adjuvant breast and bowel project adjuvant studies (C-01, C-02, C-03 and C-04). J Clin Oncol 17 1349–1360 Occurrence Handle10334518 Occurrence Handle1:STN:280:DyaK1M3msFKrtQ%3D%3D

    PubMed  CAS  Google Scholar 

  28. InstitutionalAuthorNameAnonymous. (1999) ArticleTitleIntranational Multicentre Pooled Analysis of B2 Colon Cancer Trials (IMPACT B2) investigators. Efficacy of adjuvant fluorouracil and folinic acid in B2 colon cancer. J Clin Oncol 17 1356–1368

    Google Scholar 

  29. NS Goldstein (2002) ArticleTitleLymph node recoveries from 2427 pT3 colorectal resection specimens spanning 45 years: recommendations for a minimum number of recovered lymph nodes based on predictive probabilities. Am J Surg Pathol 26 179–189 Occurrence Handle11812939 Occurrence Handle10.1097/00000478-200202000-00004

    Article  PubMed  Google Scholar 

  30. S Caplin JP Cerottini FT Bosman MT Constanda JC Givel (1998) ArticleTitleFor patients with Dukes’ B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer 83 666–672 Occurrence Handle9708929 Occurrence Handle10.1002/(SICI)1097-0142(19980815)83:4<666::AID-CNCR6>3.0.CO;2-I Occurrence Handle1:STN:280:DyaK1cznt1Klsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  31. GT Deans M Heatley N Anderson et al. (1994) ArticleTitleJass’ classification revisited. J Am Coll Surg 179 11–17 Occurrence Handle8019715 Occurrence Handle1:STN:280:DyaK2c3ptVOgtg%3D%3D

    PubMed  CAS  Google Scholar 

  32. JR Jass Y Ajioka JP Allen et al. (1996) ArticleTitleAssessment of invasive growth pattern and lymphocytic infiltration in colorectal cancer. Histopathology 28 543–548 Occurrence Handle8803598 Occurrence Handle10.1046/j.1365-2559.1996.d01-467.x Occurrence Handle1:STN:280:DyaK28zps1Ckug%3D%3D

    Article  PubMed  CAS  Google Scholar 

  33. F Cianchi A Palomba L Messerini et al. (2002) ArticleTitleTumor angiogenesis in lymph-node negative rectal cancer: correlation with clinicopathological parameters and prognosis. Ann Surg Oncol 9 20–26 Occurrence Handle11829426 Occurrence Handle10.1245/aso.2002.9.1.20

    Article  PubMed  Google Scholar 

  34. ER Fisher B Robinsky R Sass et al. (1989) ArticleTitleRelative prognostic value of the Dukes and the Jass systems in rectal cancer: findings from the National Surgical Adjuvant Breast and Bowel Projects (Protocol R-01). Dis Colon Rectum 32 944–949 Occurrence Handle2478350 Occurrence Handle10.1007/BF02552270 Occurrence Handle1:STN:280:DyaK3c%2Fjt1Wmsw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  35. SA Dundas RW Laing A O’Cathain et al. (1988) ArticleTitleFeasibility of new prognostic classification for rectal cancer. J Clin Pathol 41 1273–1276 Occurrence Handle3225328 Occurrence Handle10.1136/jcp.41.12.1273 Occurrence Handle1:STN:280:DyaL1M7jvFymsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  36. NA Shepherd E-P Saraga SB Love JR Jass (1989) ArticleTitlePrognostic factors in colonic cancer. Histopathology 14 613–630 Occurrence Handle2759558 Occurrence Handle10.1111/j.1365-2559.1989.tb02202.x Occurrence Handle1:STN:280:DyaL1MzjvFChsA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  37. M Ponz de Leon M Sant A Micheli et al. (1992) ArticleTitleClinical and pathologic prognostic indicators in colorectal cancer: a population-based study. Cancer 69 626–635 Occurrence Handle1730115 Occurrence Handle10.1002/1097-0142(19920201)69:3<626::AID-CNCR2820690305>3.0.CO;2-# Occurrence Handle1:STN:280:DyaK387htVOisQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  38. H Gabbert (1985) ArticleTitleMechanism of tumor invasion: evidence from in vivo observations. Cancer Metastasis Rev 4 293–309 Occurrence Handle3907822 Occurrence Handle10.1007/BF00048094 Occurrence Handle1:STN:280:DyaL28%2FnvFWhsg%3D%3D

    Article  PubMed  CAS  Google Scholar 

  39. L Ludeman NA Shepherd (2005) ArticleTitleSerosal involvement in gastrointestinal cancer: its assessment and significance. Histopathology 47 123–31 Occurrence Handle16045772 Occurrence Handle10.1111/j.1365-2559.2005.02189.x Occurrence Handle1:STN:280:DC%2BD2MzoslygtA%3D%3D

    Article  PubMed  CAS  Google Scholar 

  40. N Khankhanian GM Mavligit WO Russell M Schimek (1977) ArticleTitlePrognostic significance of vascular invasion in colorectal cancer of Dukes’ B class. Cancer 39 1195–1200 Occurrence Handle912654 Occurrence Handle10.1002/1097-0142(197703)39:3<1195::AID-CNCR2820390327>3.0.CO;2-A Occurrence Handle1:STN:280:DyaE1c%2Fit1emtQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

  41. BD Minsky C Mies TA Rich A Recht JT Chaffey (1988) ArticleTitlePotentially curative surgery of colon cancer: the influence of blood vessel invasion. J Clin Oncol 6 119–127 Occurrence Handle2826712 Occurrence Handle1:STN:280:DyaL1c%2FovFOrsw%3D%3D

    PubMed  CAS  Google Scholar 

  42. HE Mulcahy M Toner SE Patchett L Daly DP O’Donoghue (1997) ArticleTitleIdentifying Stage B colorectal cancer patients at high risk of tumor recurrence and death. Dis Colon Rectum 40 326–331 Occurrence Handle9118749 Occurrence Handle10.1007/BF02050424 Occurrence Handle1:STN:280:DyaK2s3ktVCnuw%3D%3D

    Article  PubMed  CAS  Google Scholar 

  43. S Merkel U Mansmann M Siassi T Papadopoulos W Hohenberger P Hermanek (2001) ArticleTitleThe prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis 16 305–306 Occurrence Handle10.1007/s003840100350

    Article  Google Scholar 

  44. JT Brodsky GK Richard AM Cohen BD Minsky (1992) ArticleTitleVariables correlated with the risk of lymph node metastasis in early rectal cancer. Cancer 15 322–326 Occurrence Handle10.1002/1097-0142(19920115)69:2<322::AID-CNCR2820690208>3.0.CO;2-B

    Article  Google Scholar 

  45. N Wolmark B Fisher HS Wieand (1986) ArticleTitleThe prognostic value of the modifications of the Dukes’ C class of colorectal cancer. Ann Surg 203 115–122 Occurrence Handle3511864 Occurrence Handle10.1097/00000658-198602000-00001 Occurrence Handle1:STN:280:DyaL287ivFKjsQ%3D%3D

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

The authors thank Professor Mary Forrest for assistance.

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Authors and Affiliations

  1. Department of General Surgery, University of Florence, Florence, Italy

    Fabio Cianchi M.D., Federico Perna M.D., Giuliano Perigli M.D. & Camillo Cortesini M.D.

  2. Department of Human Pathology and Oncology, University of Florence, Florence, Italy

    Luca Messerini M.D. & Camilla Eva Comin M.D., Ph.D.

  3. Department of Public Health, University of Florence, Florence, Italy

    Vieri Boddi B.S.

  4. Dipartimento di Area Critica Medico-Chirurgica, Viale Morgagni 85, 50134, Firenze, Italy

    Fabio Cianchi M.D.

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  1. Fabio Cianchi M.D.
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  2. Luca Messerini M.D.
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  3. Camilla Eva Comin M.D., Ph.D.
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  4. Vieri Boddi B.S.
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  5. Federico Perna M.D.
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  6. Giuliano Perigli M.D.
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  7. Camillo Cortesini M.D.
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Corresponding author

Correspondence to Fabio Cianchi M.D..

Additional information

Supported by grants from the Italian Ministry of University, Scientific and Technological Research, the Ente Cassa di Risparmio di Firenze, and the Associazione Italiana Ricerca sul Cancro.

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Cianchi, F., Messerini, L., Comin, C.E. et al. Pathologic Determinants of Survival After Resection of T3N0 (Stage IIA) Colorectal Cancer: Proposal for a New Prognostic Model. Dis Colon Rectum 50, 1332–1341 (2007). https://doi.org/10.1007/s10350-007-0222-9

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