Benefit of the measurement of mesorectal extension in patients with pT3N1-2 rectal cancer without pre-operative chemoradiotherapy: Post-operative treatment strategy

Akagi,Yoshito; Shirouzu,Kazuo; Fujita,Shin; Ueno,Hideki; Takii,Yasumasa; Komori,Koji; Ito,Masaaki; Sugihara,Kenichi

doi:10.3892/etm.2012.858

Benefit of the measurement of mesorectal extension in patients with pT3N1-2 rectal cancer without pre-operative chemoradiotherapy: Post-operative treatment strategy

Authors:
- Yoshito Akagi
- Kazuo Shirouzu
- Shin Fujita
- Hideki Ueno
- Yasumasa Takii
- Koji Komori
- Masaaki Ito
- Kenichi Sugihara
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Affiliations: Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan, Colorectal Surgery Division, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan, Department of Surgery, National Defense Medical College, Saitama, Japan, Division of Surgery, Niigata Cancer Center Hospital, Niigata, Japan, Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan, Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan, Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
Published online on: December 14, 2012 https://doi.org/10.3892/etm.2012.858
Pages: 661-666

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Abstract

A treatment strategy based on the distance of mesorectal extension (DME) for pT3N1-2 rectal cancer patients without pre-operative chemoradiotherapy has not yet been defined. The present study aimed to describe the benefit of the measurement of mesorectal extension in stratifying treatment for pT3N1-2 rectal cancer patients. Data from 512 patients with pT3N1-2 rectal cancer undergoing curative surgery at 28 institutes were analyzed in this study. DME was measured histologically, and the optimal prognostic cut-off point of the DME was determined using Cox regression analyses. Survival was calculated using the Kaplan‑Meier method. The patients were subdivided into two groups based on the optimal prognostic cut-off point: DME ≤4 mm and DME >4 mm. The DME was found to be a powerful independent risk factor for predicting distant and local recurrences. The recurrence‑free 5-year survival rates of patients with DME >4 mm were significantly poorer for Stages IIIB (53.3%; p=0.0015; HR, 1.76; 95% CI, 1.233-2.501) and IIIC (32.9%; p=0.0095; HR, 1.64; 95% CI, 1.119-2.407) than for patients with DME ≤4 mm (69.7 and 50.4%, respectively). The cancer-specific survival rates of patients with DME >4 mm were also significantly worse than those with DME ≤4 mm. A value of 4 mm provides the best cut-off point for subdividing the mesorectal extension to predict oncologic outcomes. Measurement of mesorectal extension appears to be of benefit in stratifying patients for post-operative adjuvant treatments.

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1.	Cawthorn SJ, Parums DV, Gibbs NM, et al: Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet. 1:1055–1059. 1990. View Article : Google Scholar : PubMed/NCBI
2.	Hermanek P, Henson DE, Hutter RVP, et al: TNM Supplement. A Commentary on Uniform Use. Springer; New York, NY: 1993
3.	Willett CG, Badizadegan K, Ancukiewicz M and Shellito PC: Prognostic factors in stage T3N0 rectal cancer: Do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum. 42:167–173. 1990. View Article : Google Scholar
4.	Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W and Hermanek P: The prognostic inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 16:298–304. 2001. View Article : Google Scholar : PubMed/NCBI
5.	Steel MC, Woods R, Mackay JM and Chen F: Extent of mesorectal invasion is a prognostic indicator in T3 rectal carcinoma. ANZ J Surg. 72:483–487. 2002. View Article : Google Scholar : PubMed/NCBI
6.	Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H and Talbot IC: Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg. 243:492–497. 2006. View Article : Google Scholar
7.	Katsumata D, Fukui H, Ono Y, et al: Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: the usefulness of elastic stain for its measurement. Surg Today. 38:115–122. 2008.PubMed/NCBI
8.	Yoshida K, Yoshimatsu K, Otani T, Yokomizo H and Ogawa K: The depth of invasion beyond the outer border of the muscularis propria as a prognostic factor for T3 rectal/rectosigmoid cancer. Anticancer Res. 28:1773–1778. 2008.PubMed/NCBI
9.	Tokoro T, Okuno K, Hida J, Ishimaru E, Ueda K and Yoshifuji T: Depth of mesorectal invasion has prognositic significance in T3N0 low rectal cancer. Hepatogastroenterology. 56:124–127. 2009.PubMed/NCBI
10.	Bori R, Sejben I, Svebis M, et al: Heterogeneity of pT3 colorectal carcinomas according to the depth of invasion. Pathol Oncol. 15:527–532. 2009. View Article : Google Scholar : PubMed/NCBI
11.	Pollheimer MJ, Kornprat P, Pollheimer VS, et al: Clinical significance of pT sub-classification in surgical pathology of colorectal cancer. Int J Colorectal Dis. 25:187–196. 2010. View Article : Google Scholar : PubMed/NCBI
12.	Picon AI, Moore HG, Sternberg SS, et al: Prognostic significance of depth of gross or microscopic perirectal fat invasion in T3 N0 M0 rectal cancers following sharp mesorectal excision and no adjuvant therapy. Int J Colorectal Dis. 18:487–492. 2003. View Article : Google Scholar
13.	Swedish Rectal Cancer Trial: Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 336:980–987. 1997. View Article : Google Scholar : PubMed/NCBI
14.	Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van Krieken JH, Leer JW and van de Velde CJ; Dutch Colorectal Cancer Group: Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 345:638–646. 2001. View Article : Google Scholar : PubMed/NCBI
15.	Sobin LH and Wittekind C: UICC TNM Classification of Malignant Tumours. 6th edition. Wiley-Liss; Hoboken, NJ: 2002
16.	Greene FL, Page DL, Fleming ID, et al: AJCC Cancer Staging Manual. 6th Edition. Springer; New York, NY: 2002, View Article : Google Scholar
17.	Japanese Society for Cancer of the Colon and Rectum (JSCCR): Japanese Classification of Colorectal Carcinoma. 2nd English edition. Kanehara & Co., Ltd; Tokyo: 2009
18.	Shirouzu K, Akagi Y, Fujita S, et al: Clinical significance of mesorectal extension of rectal cancer. A Japanese multi-institutional study. Ann Surg. 253:704–710. 2011. View Article : Google Scholar
19.	Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW and Williams GT: Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging. Br J Surg. 90:355–364. 2003. View Article : Google Scholar : PubMed/NCBI
20.	MERCURY Study Group: Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer. Results of the MERCURY study. Radiology. 243:132–139. 2007. View Article : Google Scholar : PubMed/NCBI