A 5− to 21-Year Follow-up and Analysis of 250 Patients with Rectal Adenocarcinoma

Abstract

A total of 250 patients with rectal adenocarcinoma were operated on at the University of Chicago Medical Center between 1965 and 1981. The operation performed was curative resection in 154 patients, palliative resection in 16 patients, diverting colostomy in 21 patients, exploratory laparotomy in 11 patients, and transanal removal in 48 patients. Of the 154 curative resections, 115 were abdomino-perineal (APR), three were total proctocolectomies, and 36 were low anterior resections (LAR). No anastomotic complications were observed in this latter group. Operative mortality was 3%. Complete follow-up was obtained in 152 patients (98.7%). Five- and 10-year actuarial survival rates were 68.8 and 59.4%, respectively, for patients with Dukes' B1 adenocarcinoma (n = 32), 55.8 and 44.2% for Dukes' B2 tumors (n = 52), and 42.9% and 25.4% for Dukes' C tumors (n = 63). Distant metastases developed in 59 patients (39.6%), and pelvic recurrence developed in another 18 patients (12%); 5-year survival rates were 23.6% and 22.2%, respectively. Multivariate analysis with Cox regression showed that stage (p = 0.0001), race (p = 0.03), tumor morphology (p = 0.02), and vascular and/or lymphatic microinvasion (p = 0.001) were statistically significant in their association with survival. Logistic regression analysis confirmed these results and allowed for the estimation of 5-year survival probabilities in 16 groups of patients defined by various associations of these four factors. These estimates ranged from a high of 92% in Caucasian patients with Stage B, exophytic tumors with no vascular or lymphatic microinvasion, to a low of 14% in black patients with Stage C, nonexophytic tumors and with the presence of vascular and/or lymphatic microinvasion. Univariate analysis showed that histologic type (p = 0.0006), stage (p = 0.05) and vascular and/or lymphatic microinvasion (p less than 0.001) were significantly associated with the incidence of pelvic recurrence. Analysis of the extent of the operation revealed that the incidence of pelvic recurrence was reduced by the performance of a wide pelvic lymphadenectomy (9.4% vs. 16.4%), but the result did not reach statistical significance (p = 0.16). In conclusion, this study confirms the well-established prognostic value of the Dukes' staging classification of rectal carcinoma. Further, the analysis reveals that race, tumor morphology, and the presence or absence of lymphatic and/or vascular microinvasion significantly influence outcome. By associating these four statistically significant and independent variables, the prognosis for any individual patient can be estimated more precisely than by using Dukes' staging alone.(ABSTRACT TRUNCATED AT 400 WORDS)

Expression Profile of Cancer-Testis Genes in 121 Human Colorectal Cancer Tissue and Adjacent Normal Tissue

“…By multivariate analysis method, the presence of vessel emboli is well correlated with metastasis and can be an independent prognostic factor for poor prognosis of CRC (30,31). So we speculate that MAGE-4 can possibly predict the potential of metastasis and poor prognosis on the molecular level.…”

Importância da invasão neural e linfática no prognóstico do adenocarcinoma colorretal

“…Assim, em nossa opinião, doentes com tais características deveriam ser submetidos a tratamento quimioterápico complementar e intensivo acompanhamento. O valor prognóstico da invasão dos vasos linfáticos também é controverso, predominando os que realçam sua importância prognóstica 9,[12][13][14][15] , embora outros estudiosos não tenham constatado tal influência 5,7,19 . Ela não foi considerada de importância prognóstica quando do estudo de 211 carcinomas retais no estádio I 8 .…”

“…No entanto, também foi constatada significante redução da sobrevida em portadores de lesões exibindo células tumorais nos vasos linfáticos [9][10][11][12][13][14][15] . Mais recentemente, Compton et al, analisando múltiplos fatores prognósticos destas neoplasias, incluíram a invasão dos vasos linfá-ticos como fator de grande importância prognóstica 6 .…”

Urological reconstruction after pelvic oncological surgery: A single institution experience

“…The tumor grade and lymphovascular invasion have direct correlations with survival, as consistent with larger studies. 29,30 Both patients who had high grade tumor, despite clear resection margins, had recurrences, at 2 months and 7 months, respectively, while in the remaining group with moderately differentiated cancer, six out of nine had recurrences, at a median time of 10.8 months (range 5e21 months). Of the eight patients that recurred, seven had lymphovascular invasion on final histology.…”