Gross tümör volumü ve az diferansiye kümeler pT1- 2 rektum karsinomlarında kötü sağ kalım açısından yüksek riskli hastaları gösterebilir

Abstract

Aim: Colorectal carcinomas are one of the most common carcinomas in the Western world. Survival is mainly associated with the tumour-node-metastasis (TNM) stage but patients with the same tumour stage usually show marked distinct survival. We analyzed the survival effect of gross tumour volume and poorly differentiated clusters in pT1-2 rectal carcinomas. Material and Method: Sixty-five pT1-2 rectal carcinomas that were curatively resected between 1999 and 2014 were included in this retrospective study at Kırıkkale University Medical Faculty Hospital. Gross tumour volume and poorly differentiated clusters were scored using a macroscopic specimen and hematoxylin and eosin-stained sections. Results: These parameters were significantly associated with large tumour size (gross tumour volume [GTV]: p=0.020), invasive pattern (GTV: p=0.004; poorly differentiated clusters [PDC]: p=0.020), angiolymphatic invasion (GTV: p=0.001; PDC: p=0.009), tumour necrosis (GTV: p=0.002; PDC: p=0.038), and high grade (PDC: p=0.001). In univariate analysis, patients with these parameters had worse 5-year survival for both relapse-free survival (RFS) and overall survival (OS) ([GTV: RFS= 78.5%, p=0.001; OS: 81.0%, p=0.005], [PDC: RFS= 80.0%, p=0.013; OS: 83.1%, p=0.039]). Multivariate analysis confirmed that these parameters are independent predictors of poor survival for RFS (GTV: Hazard ratio [HR]=1.42 [1.06-2.85], p=0.006; PDC: HR=1.39 [1.06-3.28], p=0.028) and OS (GTV: HR=1.35 [1.09-3.37], p=0.011). Also, GTV was found to be more useful than PDC.Conclusions: According to our study, GTV and PDC play an important role in the prognosis of rectal carcinomas and the addition of these markers to the current risk classification may contribute to better patient selection.