Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone Journal Article


Authors: Nissan, A.; Stojadinovic, A.; Shia, J.; Hoos, A.; Guillem, J. G.; Klimstra, D.; Cohen, A. M.; Minsky, B. D.; Paty, P. B.; Wong, W. D.
Article Title: Predictors of recurrence in patients with T2 and early T3, N0 adenocarcinoma of the rectum treated by surgery alone
Abstract: Purpose: Treatment of rectal cancer with neoadjuvant radiotherapy has been shown to reduce local recurrence and improve overall survival. The role of chemoradiotherapy in patients with T2, N0 and early T3, N0 rectal cancer, treated by radical surgery with total mesorectal excision, remains controversial. The aim of this study was to identify predictors of recurrence in this group of patients to enhance treatment selection. Patients and Methods: One hundred patients with primary T2-3, N0 adenocarcinoma of the rectum, uniformly treated by surgery alone, were studied. The pathology slides available for 97 patients were rereviewed. Three patients with incomplete data sets were excluded. Clinical and survival data were obtained from a prospective computerized database and updated from hospital and office charts. The study end points were disease-free survival, disease-specific survival (DSS), time to pelvic recurrence (PR), and distant recurrence. Results: Complete follow-up was available for all study patients. Median follow-up was 79.5 months (range, 57.7 to 105.9 months). During this time period 30 patients (31.9%) died as a result of disease and 64 patients (68.1 %) remained alive and disease free. Five-year DSS was 73%. The cumulative risk for PR was 8% at 5 years and 10% at 8 years. Lymphovascular invasion, preoperative serum carcinoembryonic antigen (CEA > 5 ng/mL) level, and age older than 70 years were all associated with adverse outcome. Conclusion: Patients with T2-3, N0 rectal cancers and either lymphovascular invasion or elevated CEA levels have reduced survival and a higher incidence of PR, and should be considered for future randomized trials. © 2006 by American Society of Clinical Oncology.
Keywords: adult; cancer survival; treatment outcome; aged; major clinical study; cancer recurrence; cancer patient; disease free survival; follow up; carcinoembryonic antigen; prediction; cancer invasion; rectum carcinoma
Journal Title: Journal of Clinical Oncology
Volume: 24
Issue: 25
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2006-09-01
Start Page: 4078
End Page: 4084
Language: English
DOI: 10.1200/jco.2006.06.2968
PROVIDER: scopus
DOI/URL:
Notes: --- - "Cited By (since 1996): 28" - "Export Date: 4 June 2012" - "CODEN: JCOND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Philip B Paty
    373 Paty
  2. Bruce Minsky
    264 Minsky
  3. Axel Hoos
    28 Hoos
  4. Aviram Nissan
    20 Nissan
  5. Jose Guillem
    373 Guillem
  6. Alfred M Cohen
    175 Cohen
  7. David S Klimstra
    852 Klimstra
  8. Jinru Shia
    465 Shia
  9. Douglas W Wong
    173 Wong