Adjuvant therapy for T3N0 rectal cancer in the total mesorectal excision era- identification of the high risk patients

Ji Zhu,Guoxiang Cai,Ye Xu,Sanjun Cai,Wenjie Sun,Gang Cai,Weiqi Shen,Zhen Zhang,Junjie Peng,Weilie Gu

doi:10.1186/1748-717x-5-118

Abstract

BackgroundAdjuvant therapy for T3N0 rectal cancer was controversial with respect to both radiation and the use of a combined regimen of chemotherapy. We evaluated both clinical features and biomarkers and sought to determine risk factors for those patients retrospectively.MethodsA total of 122 patients with T3N0 rectal cancer were analyzed in this study from January 2000 to December 2005. Clinicopathologic and biomarkers were used to predict local recurrence (LR), disease-free survival (DFS), and overall survival (OS).ResultsThe median follow-up interval was 45.4 months. Five-year LR, DFS, and OS rates were 10.4%, 68.3%, and 88.7%. Having a lower tumor location and showing low P21 and high CD44v6 expression were identified as risk factors for LR: patients with two or three of these risk factors had a higher 5-year LR rate (19.3%) than did patients with none or one of these risk factors (6.8%) (p = 0.05). A poorer DFS was related to low P21 nor high CD44v6 expression but not to tumor location: the 5-year DFS rates were 79.3% for those with neither, 65.9% for those with either one or the other, and 16.9% for those with both (p = 0.00).ConclusionsThe prognostic model including tumor location, P21 and CD44v6 expressions could help to distinguish these patients with high risk T3N0 patients and determine whether adjuvant therapy was beneficial.

Highlights

Current guidelines from the National Comprehensive Cancer Network recommend that all patients with clinical stage II/III rectal cancer should be treated with preoperative chemoradiation followed by total mesorectal excision (TME)
Some investigators have evaluated potential risk factors with the intent of identifying the best type of adjuvant therapy for rectal cancer, but those studies were conducted before the advent of total mesorectal excision (TME) [4,5], which greatly reduces the risk of local relapse compared with conventional surgery [6]
We evaluated a variety of clinicopathological factors and molecular markers in patients with pathogically staged T3N0 rectal cancer after TME, with the goal of identifying factors related to predicting outcome

Summary

Introduction

Current guidelines from the National Comprehensive Cancer Network recommend that all patients with clinical stage II/III rectal cancer should be treated with preoperative chemoradiation followed by total mesorectal excision (TME). Some investigators have evaluated potential risk factors with the intent of identifying the best type of adjuvant therapy for rectal cancer, but those studies were conducted before the advent of total mesorectal excision (TME) [4,5], which greatly reduces the risk of local relapse compared with conventional surgery [6]. Adjuvant therapy for T3N0 rectal cancer was controversial with respect to both radiation and the use of a combined regimen of chemotherapy We evaluated both clinical features and biomarkers and sought to determine risk factors for those patients retrospectively

Methods

Results

Discussion

Conclusion