Importance of tumor regression assessment in predicting the outcome in patients with locally advanced rectal carcinoma who are treated with preoperative radiotherapy

被引:217
作者
Bouzourene, H
Bosman, FT
Seelentag, W
Matter, M
Coucke, P
机构
[1] CHU Vaudois, Inst Pathol, CH-1011 Lausanne, Switzerland
[2] CHU Vaudois, Dept Surg, CH-1011 Lausanne, Switzerland
[3] CHU Vaudois, Dept Radiat Oncol, CH-1011 Lausanne, Switzerland
关键词
tumor regression; preoperative radiotherapy; locally advanced colorectal carcinoma; survival;
D O I
10.1002/cncr.10327
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND: Locally advanced rectal carcinoma has a poor prognosis. However, since the introduction of preoperative radiotherapy, the outcome of patients with rectal carcinoma has been reported to have improved. Nevertheless, to the authors' knowledge few data are available regarding the histopathologic response to radiotherapy as assessed on surgical specimens as a potential predictive factor for outcome. METHODS: To estimate the effect of radiotherapy on rectal carcinoma, the authors retrospectively reviewed the surgical specimens of 102 patients with T3-4, N0 or greater than or equal to N1 rectal carcinoma and 1 patient with T2 but NI rectal carcinoma. All patients were treated preoperatively with a hyperfractionated accelerated radiotherapy schedule in a prospective protocol (Trial 93-01). Using a standardized approach, tumor regression was graded using a system that varies from Grade I (tumor regression Grade [TRG] 1) when complete tumor regression is observed to Grade 5 (TRG5) when no tumor regression is observed. RESULTS: Radiotherapy resulted in tumor downstaging in 43% of the patients. There were 2 pT1 tumors (2%), 21 pT2 tumors (20%), 66 pT3 tumors (64%), and 14 pT4 tumors (14%) after treatment. Regional lymph nodes were involved in 55 patients (53%). None of the patients demonstrated a complete tumor regression after radiotherapy, but in 79% of the specimens a partial tumor regression was observed (TRG1: 0%; TRG2: 20%; TRG3: 39%; TRG4: 20%; and TRG5: 21%). The median actuarial overall survival (OS) and disease-free survival (DFS) were 52 months. Actuarial local recurrence rates at 2 years and 5 years were 6.4% and 7.6%, respectively. Univariate analysis showed the actuarial DFS to be significantly lower in patients with lymph node metastases (P = 0.0004) and advanced pT stages (pT3-4) (P = 0.03). A favorable outcome for OS, DIPS, and local control was observed in patients with TRG2-4 (i.e., responders) compared with patients with TRG5 (i.e., nonresponders), but also in patients with low residual tumor cell density (TRG2, 3, and 4). On multivariate analysis, TRG remained an independent prognostic indicator for local tumor control. CONCLUSIONS. Tumor regression as well as residual tumor cell density were found to be predictive factors of survival in rectal carcinoma patients after preoperative radiotherapy. Even after preoperative radiotherapy, the pathologic stage of the surgical specimen remained a prognostic factor. The use of a standardized approach for pathologic evaluation must be implemented to allow comparison between the results of various treatment approaches. (C) 2002 American Cancer Society.
引用
收藏
页码:1121 / 1130
页数:10
相关论文
共 51 条
[1]   ROLE OF CIRCUMFERENTIAL MARGIN INVOLVEMENT IN THE LOCAL RECURRENCE OF RECTAL-CANCER [J].
ADAM, IJ ;
MOHAMDEE, MO ;
MARTIN, IG ;
SCOTT, N ;
FINAN, PJ ;
JOHNSTON, D ;
DIXON, MF ;
QUIRKE, P .
LANCET, 1994, 344 (8924) :707-711
[2]  
Ahmad NR, 1997, BRIT J SURG, V84, P1445
[3]  
[Anonymous], 1990, Cancer, V66, P49
[4]  
[Anonymous], 1996, Ann Surg Oncol, V3, P423
[5]  
BALSLEV IB, 1986, CANCER-AM CANCER SOC, V58, P22, DOI 10.1002/1097-0142(19860701)58:1<22::AID-CNCR2820580106>3.0.CO
[6]  
2-Q
[7]   Preoperative radiotherapy (RT) for rectal cancer: Predictive factors of tumor downstaging and residual tumor cell density (RTCD): Prognostic implications [J].
Berger, C ;
deMuret, A ;
Garaud, P ;
Chapet, S ;
Bourlier, P ;
ReynaudBougnoux, A ;
Dorval, E ;
deCalan, L ;
Huten, N ;
leFloch, O ;
Calais, G .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1997, 37 (03) :619-627
[8]  
BOSSET JF, 1986, GASTROEN CLIN BIOL, V10, P728
[9]   Preoperative radiotherapy for resectable cancer of the middle-distal rectum: Its effect on the primary lesion as determined by endorectal ultrasound using flexible echo colonoscope [J].
Bozzetti, F ;
Andreola, S ;
Rossetti, C ;
Zucali, R ;
Meroni, E ;
Baratti, D ;
Bertario, L ;
Doci, R ;
Gennari, L .
INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 1996, 11 (06) :283-286
[10]   Preoperative radiotherapy for resectable rectal cancer -: A meta-analysis [J].
Cammà, C ;
Giunta, M ;
Fiorica, F ;
Pagliaro, L ;
Craxì, A ;
Cottone, M .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 284 (08) :1008-1015