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. 1988 Aug;58(2):195–201. doi: 10.1038/bjc.1988.192

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?

S M Bentzen 1, I Balslev 1, M Pedersen 1, P S Teglbjaerg 1, F Hanberg-Soerensen 1, J Bone 1, N O Jacobsen 1, J Overgaard 1, A Sell 1, K Bertelsen 1, et al.
PMCID: PMC2246758  PMID: 3166910

Abstract

The prognostic value of several clinical and histopathological characteristics has been evaluated in patients with Dukes' B and C carcinoma of the rectum and the rectosigmoid. Data on 260 Dukes' B and 208 Dukes' C tumours entered into a prospective, randomized clinical trial of post-operative radiotherapy (50 Gy given with 2 Gy/fraction in an overall time of 7 weeks) were analyzed by means of the Cox proportional hazards model. The Dukes' stages B and C were analyzed in two separate multivariate analyses. In patients with Dukes' B tumours, a poor prognosis was associated with age above 60, perineural and venous invasion, tumour located less than 10 cm from the anal verge and elevated pre-operative carcinoembryonic antigen (CEA) (greater than 3.2 ng ml-1). In patients with Dukes' C tumours, perineural and venous invasion, tumour located less than 10 cm from the anal verge, and elevated pre-operative CEA were associated with a poor prognosis. In addition, a large tumour diameter had a strong, negative influence on the prognosis. Males seemed to have a poorer prognosis than females among the Dukes' C patients. Resection of neighbouring organs was also associated with a poor prognosis in this stage. Post-operative radiotherapy as administered in the present series had no significant influence on prognosis. Based on the derived prognostic models patients with a hazard of death above the median in each stage were selected. A separate analysis of the survival in these high risk patients showed no survival benefit from radiotherapy. The proportional hazards model may be a useful tool in selecting patients for more aggressive adjuvant treatment.

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Selected References

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  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. 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]
  3. 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]
  4. 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]
  5. Gerard A., Berrod J. L., Pene F., Loygue J., Laugier A., Bruckner R., Camelot G., Arnaud J. P., Metzger U., Buyse M. Interim analysis of a phase III study on preoperative radiation therapy in resectable rectal carcinoma. Trial of the Gastrointestinal Tract Cancer Cooperative Group of the European Organization for Research on Treatment of Cancer (EORTC). Cancer. 1985 May 15;55(10):2373–2379. doi: 10.1002/1097-0142(19850515)55:10<2373::aid-cncr2820551012>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  6. Green J. P. Rectal cancer: adjuvant radiation therapy. Front Radiat Ther Oncol. 1980;15:102–108. doi: 10.1159/000394376. [DOI] [PubMed] [Google Scholar]
  7. Grinnell R. S. Lymphatic Metastases of Carcinoma of the Colon and Rectum. Ann Surg. 1950 Apr;131(4):494–506. doi: 10.1097/00000658-195004000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Hoskins R. B., Gunderson L. L., Dosoretz D. E., Rich T. A., Galdabini J., Donaldson G., Cohen A. M. Adjuvant postoperative radiotherapy in carcinoma of the rectum and rectosigmoid. Cancer. 1985 Jan 1;55(1):61–71. doi: 10.1002/1097-0142(19850101)55:1<61::aid-cncr2820550111>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  9. Jass J. R., Atkin W. S., Cuzick J., Bussey H. J., Morson B. C., Northover J. M., Todd I. P. The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases. Histopathology. 1986 May;10(5):437–459. doi: 10.1111/j.1365-2559.1986.tb02497.x. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. 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]
  12. Miller W., Ota D., Giacco G., Guinee V., Irimura T., Nicolson G., Cleary K. Absence of a relationship of size of primary colon carcinoma with metastasis and survival. Clin Exp Metastasis. 1985 Jul-Sep;3(3):189–196. doi: 10.1007/BF01786762. [DOI] [PubMed] [Google Scholar]
  13. Newland R. C., Chapuis P. H., Pheils M. T., MacPherson J. G. The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases. Cancer. 1981 Mar 15;47(6):1424–1429. doi: 10.1002/1097-0142(19810315)47:6<1424::aid-cncr2820470630>3.0.co;2-o. [DOI] [PubMed] [Google Scholar]
  14. 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]
  15. 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]
  16. Sischy B. The place of radiotherapy in the management of rectal adenocarcinoma. Cancer. 1982 Dec 1;50(11 Suppl):2631–2637. [PubMed] [Google Scholar]
  17. Spratt J. S., Jr, Spjut H. J. Prevalence and prognosis of individual clinical and pathologic variables associated with colorectal carcinoma. Cancer. 1967 Nov;20(11):1976–1985. doi: 10.1002/1097-0142(196711)20:11<1976::aid-cncr2820201125>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  18. Svennevig J. L., Lunde O. C., Holter J., Bjørgsvik D. Lymphoid infiltration and prognosis in colorectal carcinoma. Br J Cancer. 1984 Mar;49(3):375–377. doi: 10.1038/bjc.1984.60. [DOI] [PMC free article] [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. Thynne G. S., Weiland L. H., Moertel C. G., Silvers A. Correlation of histopathologic characteristics of primary tumor and uninvolved regional lymph nodes in Dukes' class C colonic carcinoma with prognosis. Mayo Clin Proc. 1980 Apr;55(4):243–245. [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]
  22. Wolmark N., Fisher B., Wieand H. S. The prognostic value of the modifications of the Dukes' C class of colorectal cancer. An analysis of the NSABP clinical trials. Ann Surg. 1986 Feb;203(2):115–122. doi: 10.1097/00000658-198602000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]

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