Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1992 Jan;65(1):102–107. doi: 10.1038/bjc.1992.19

Time to loco-regional recurrence after resection of Dukes' B and C colorectal cancer with or without adjuvant postoperative radiotherapy. A multivariate regression analysis.

S M Bentzen 1, I Balslev 1, M Pedersen 1, P S Teglbjaerg 1, F Hanberg-Sørensen 1, J Bone 1, N O Jacobsen 1, A Sell 1, J Overgaard 1, K Bertelsen 1, et al.
PMCID: PMC1977364  PMID: 1733432

Abstract

Factors influencing time to loco-regional recurrence were identified in a multivariate regression analysis of data from a series of 468 radically operated patients (260 Dukes' B and 208 Dukes' C) with carcinoma of the rectum and the rectosigmoid. A number of clinical and pathological characteristics were prospectively collected and recorded. In addition, carcinoembryonic antigen (CEA) was measured within 1 week before surgery. The endpoint used was recurrence below the level of the umbilicus. All patients were followed for at least 5 years or until time of death. The two Dukes' stages B and C were analysed in two separate analyses using the Cox proportional hazards model. In patients with Dukes' B tumours, an increased risk of loco-regional recurrence was associated with perineural invasion, tumour located less than 10 cm from the anal verge, patient aged above 70 years, and small tumour size. In patients with Dukes' C tumours, the necessity to resect neighbour organs, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and large tumour size were all associated with a poor loco-regional outcome. Postoperative radiotherapy was not a significant prognosticator for loco-regional control. An update of the 5-year results of the randomised study of post-operative radiotherapy (50 Gy with 2 Gy per fraction in an overall treatment time of 7 weeks) showed no survival benefit from adjuvant radiotherapy in either Dukes' category and no statistically significant improvement in the 5-year loco-regional control rate. However, when the comparison was restricted to a group of high-risk patients there was a statistically significant benefit from radiotherapy with respect to loco-regional control (P = 0.03) but not with respect to survival (P = 0.23). The potential advantage, in terms of the required number of patients, of restricting clinical trials of intensified loco-regional therapies to the high-risk patients, is illustrated.

Full text

PDF
104

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balslev I., Pedersen M., Teglbjaerg P. S., Hanberg-Sørensen F., Bone J., Jacobsen N. O., Overgaard J., Sell A., Bertelsen K., Hage E. Postoperative radiotherapy in rectosigmoid cancer Dukes' B and C: interim report from a randomized multicentre study. Br J Cancer. 1982 Oct;46(4):551–556. doi: 10.1038/bjc.1982.239. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bentzen S. M., Balslev I., Pedersen M., Teglbjaerg P. S., Hanberg-Soerensen F., Bone J., Jacobsen N. O., Overgaard J., Sell A., Bertelsen K. A regression analysis of prognostic factors after resection of Dukes' B and C carcinoma of the rectum and rectosigmoid. Does post-operative radiotherapy change the prognosis? Br J Cancer. 1988 Aug;58(2):195–201. doi: 10.1038/bjc.1988.192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bentzen S. M., Balslev I., Pedersen M., Teglbjaerg P. S., Hanberg-Sørensen F., Bone J., Jacobsen N. O., Sell A., Overgaard J., Bertelsen K. Blood transfusion and prognosis in Dukes' B and C colorectal cancer. Eur J Cancer. 1990 Apr;26(4):457–463. doi: 10.1016/0277-5379(90)90016-m. [DOI] [PubMed] [Google Scholar]
  4. Bentzen S. M., Poulsen H. S., Kaae S., Jensen O. M., Johansen H., Mouridsen H. T., Daugaard S., Arnoldi C. Prognostic factors in osteosarcomas. A regression analysis. Cancer. 1988 Jul 1;62(1):194–202. doi: 10.1002/1097-0142(19880701)62:1<194::aid-cncr2820620129>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
  5. Block G. E., Enker W. E. Survival after operations for rectal carcinoma in patients over 70 years of age. Ann Surg. 1971 Sep;174(3):521–529. doi: 10.1097/00000658-197109000-00018. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chapuis P. H., Dent O. F., Fisher R., Newland R. C., Pheils M. T., Smyth E., Colquhoun K. A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg. 1985 Sep;72(9):698–702. doi: 10.1002/bjs.1800720909. [DOI] [PubMed] [Google Scholar]
  7. DUKES C. E., BUSSEY H. J. The spread of rectal cancer and its effect on prognosis. Br J Cancer. 1958 Sep;12(3):309–320. doi: 10.1038/bjc.1958.37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dahl O., Horn A., Morild I., Halvorsen J. F., Odland G., Reinertsen S., Reisaeter A., Kavli H., Thunold J. Low-dose preoperative radiation postpones recurrences in operable rectal cancer. Results of a randomized multicenter trial in western Norway. Cancer. 1990 Dec 1;66(11):2286–2294. doi: 10.1002/1097-0142(19901201)66:11<2286::aid-cncr2820661106>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  9. Douglass H. O., Jr, Moertel C. G., Mayer R. J., Thomas P. R., Lindblad A. S., Mittleman A., Stablein D. M., Bruckner H. W. Survival after postoperative combination treatment of rectal cancer. N Engl J Med. 1986 Nov 13;315(20):1294–1295. doi: 10.1056/NEJM198611133152014. [DOI] [PubMed] [Google Scholar]
  10. GEHAN E. A. A GENERALIZED WILCOXON TEST FOR COMPARING ARBITRARILY SINGLY-CENSORED SAMPLES. Biometrika. 1965 Jun;52:203–223. [PubMed] [Google Scholar]
  11. Jensen H. E., Nielsen J., Balslev I. Carcinoma of the colon in old age. Ann Surg. 1970 Jan;171(1):107–115. doi: 10.1097/00000658-197001000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mantel N. Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep. 1966 Mar;50(3):163–170. [PubMed] [Google Scholar]
  13. Mayer R. J., O'Connell M. J., Tepper J. E., Wolmark N. Status of adjuvant therapy for colorectal cancer. J Natl Cancer Inst. 1989 Sep 20;81(18):1359–1364. doi: 10.1093/jnci/81.18.1359. [DOI] [PubMed] [Google Scholar]
  14. Mohiuddin M., Derdel J., Marks G., Kramer S. Results of adjuvant radiation therapy in cancer of the rectum. Thomas Jefferson University Hospital experience. Cancer. 1985 Jan 15;55(2):350–353. doi: 10.1002/1097-0142(19850115)55:2<350::aid-cncr2820550208>3.0.co;2-3. [DOI] [PubMed] [Google Scholar]
  15. Quirke P., Durdey P., Dixon M. F., Williams N. S. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet. 1986 Nov 1;2(8514):996–999. doi: 10.1016/s0140-6736(86)92612-7. [DOI] [PubMed] [Google Scholar]
  16. Rich T., Gunderson L. L., Lew R., Galdibini J. J., Cohen A. M., Donaldson G. Patterns of recurrence of rectal cancer after potentially curative surgery. Cancer. 1983 Oct 1;52(7):1317–1329. doi: 10.1002/1097-0142(19831001)52:7<1317::aid-cncr2820520731>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  17. Seefeld P. H., Bargen J. A. THE SPREAD OF CARCINOMA OF THE RECTUM: INVASION OF LYMPHATICS, VEINS AND NERVES. Ann Surg. 1943 Jul;118(1):76–90. doi: 10.1097/00000658-194311810-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Tannock I. F. Combined modality treatment with radiotherapy and chemotherapy. Radiother Oncol. 1989 Oct;16(2):83–101. doi: 10.1016/0167-8140(89)90025-x. [DOI] [PubMed] [Google Scholar]
  19. Tepper J. E., Cohen A. M., Wood W. C., Orlow E. L., Hedberg S. E. Postoperative radiation therapy of rectal cancer. Int J Radiat Oncol Biol Phys. 1987 Jan;13(1):5–10. doi: 10.1016/0360-3016(87)90252-5. [DOI] [PubMed] [Google Scholar]
  20. Vigliotti A., Rich T. A., Romsdahl M. M., Withers H. R., Oswald M. J. Postoperative adjuvant radiotherapy for adenocarcinoma of the rectum and rectosigmoid. Int J Radiat Oncol Biol Phys. 1987 Jul;13(7):999–1006. doi: 10.1016/0360-3016(87)90037-x. [DOI] [PubMed] [Google Scholar]
  21. Wanebo H. J., Rao B., Pinsky C. M., Hoffman R. G., Stearns M., Schwartz M. K., Oettgen H. F. Preoperative carcinoembryonic antigen level as a prognostic indicator in colorectal cancer. N Engl J Med. 1978 Aug 31;299(9):448–451. doi: 10.1056/NEJM197808312990904. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES