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?

Bentzen, Søren M.; Balslev, I.; Pedersen, Morten Videbæk; Teglbjærg, Peter Stubbe; Hanberg-Soerensen, F.; Boné, J; Jacobsen, N; Overgaard, Jens; Sell, A; Bertelsen, K.

doi:10.1038/bjc.1988.192

Cited by 46 publications

(27 citation statements)

References 23 publications

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“…However, there is also considerable variation in prognosis within the Dukes' stages (Newland et al, 1987;Lindmark et al, 1994). Bentzen et al (1988) showed, for example, that some subgroups of Dukes' stage C patients had better prognosis than some subgroups of Dukes' stage B patients. For therapeutic and surveillance reasons, it is of importance to find stronger prognostic factors other than the original Dukes' classification, i.e.…”

Section: Discussionmentioning

confidence: 99%

Stromal tenascin distribution as a prognostic marker in colorectal cancer

Kressner

Lindmark²,

Tomasini-Johansson³

et al. 1997

Br J Cancer

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Summary A total of 169 colorectal adenocarcinomas, obtained from patients with a median follow-up of 6.5 years, were studied with immunohistochemical staining on cryosections using a monoclonal anti-tenascin antibody to evaluate the possible association between the staining patterns and tumour stage, tumour differentiation and survival. We found two different staining patterns in the tumour stroma -a diffuse stromal fibrillar staining in 92 out of 169 (54%) tumours and a subglandular staining in the remaining 77 tumours. When the entire group of patients (P < 0.01) and the group of potentially cured patients (P < 0.03) were analysed univariately, it was found that diffuse stromal fibrillar staining was associated with a shorter survival time than subglandular staining. In a multivariate analysis, the Dukes' stage and age were independent prognostic factors, whereas the tenascin expression did not retain a clear independent relationship to survival (P = 0.06).Hence, it appears that the tumour expression of tenascin may be a potential prognostic marker in colorectal cancer, in so far as a diffuse stromal fibrillar staining pattern seems to indicate an increased risk of poor outcome. However, after adjustment for age and Dukes' stage, the additional prognostic value of tenascin remains to be established in further analyses.Keywords: tenascin; colorectal cancer; tumour stage; tumour differentiation; survival; immunohistochemistry Tenascin is a large hexameric extracellular matrix protein that is present during embryonic development but essentially absent in normal adult tissues (Schenk and Chiquet-Ehrismann, 1994) and is expressed only at low levels or in a very restricted distribution. Several tenascin isoforms have been described . Tenascin has been suggested to be of importance in the normal healing process and in tumours, in which its role is presumed to be connected with cell adhesion and detachment, cell growth, cell migration and angiogenesis (Mackie et al, 1988;Ekblom and Aufterheide, 1989;Erickson and Bourdon, 1989; ChiquetEhrismann, 1993;Hahn et al, 1995; Joshi et al, 1995). It has been proposed that, although tenascin has no cell adhesion activity, it does affect the cell shape and, thus, may inhibit cell attachment to other extracellular proteins, including fibronectin (Mackie, 1994). It is also thought that tenascin plays a role in coordinating the provisional extracellular matrix surrounding the cancer tissue (Sakakura and Kusakabe, 1994).Several reports have shown an up-regulation of tenascin in various tumour stroma, such as breast (Moch et al, 1993;Shoji et al, 1993;Yoshida et al, 1995), lung (Natali and Zardi, 1989), prostatic (Ibrahim et al, 1993) and gastric carcinomas (Ikeda et al, 1995;Ilunga and Iriyama, 1995). Studies of this putative marker of the tumour matrix are also of considerable interest in colorectal cancer (Sugawara et al, 1991;Riedel et al, 1992;Sakai et al, 1993;Hauptmann et al, 1995;Riedel et al, 1995) because of the potential involvement of tenascin (or tenascin-like proteins) i...

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Section: Discussionmentioning

confidence: 99%

Stromal tenascin distribution as a prognostic marker in colorectal cancer

Kressner

Lindmark²,

Tomasini-Johansson³

et al. 1997

Br J Cancer

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“…Age, gender, TNM stage, venous invasion, tumour necrosis, peri-tumoural lymphocytic infiltration, tumour budding and CEA levels were also independently associated with poor survival in at least some studies [17,18,21,22,26,30,32,33,39].…”

Section: Discussionmentioning

confidence: 99%

The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: A systematic review

Wyk

Going

Horgan

et al. 2017

Critical Reviews in Oncology/Hematology

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. (2017) The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: a systematic review. Critical Reviews in Oncology/Hematology, 112, pp. 11-20. (doi:10.1016/j.critrevonc.2017 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/139181/ Therefore, the aim of the present study was to systematically review the identification and associations of perineural invasion and survival in patients with primary operable colorectal cancer. From initial search results of 912 articles, 38 studies were selected. Using H&E stains; five studies including 1835 patients reported on survival stratified by perineural invasion in colon cancer with weighted average detection rates of 26%; eleven studies including 3837 patients reported on rectal cancer with weighted average detection rates of 25% and; sixteen studies including 9145 patients reported on survival stratified by perineural invasion in colorectal cancer with weighted average detection rates of 17%. Using special techniques (S100), six studies including 1458 patients reported on the identification of perineural invasion in colorectal cancer.In comparison to H&E staining alone, the use of immunohistochemistry with S100 increased the detection of perineural invasion to approximately 70%.However, those studies did not examine the relationship with outcomes, so further research is required to establish the clinical significance of perineural invasion detected by immunohistochemistry. In conclusion, perineural invasion deserves special attention for improved prognostic stratification in patients with colorectal cancer. Further work is required to standardise pathology assessment and reporting of perineural invasion, in particular its definition, use of special stains and routine inclusion in pathology practice. Reliable assessment is required for investigations into mechanisms of perineural invasion, its role tumour spread and prognostic value.

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“…A total of 494 patients were randomised in a multicenter study (Balslev et al, 1982;Balslev et al, 1986;Bentzen et al, 1988a) of the effect of postoperative adjuvant radiotherapy after resection of Dukes' B and C colorectal cancer. The study was open for patient intake from September 1979 to March 1984 (Dukes' B) or March 1985 (Dukes' C). Staging was performed according to Dukes' classification (Dukes & Bussey, 1958), with B tumours defined as having penetrated the bowel wall completely, and C tumours as having regional lymph node metastases regardless of the degree of bowel-wall penetration.…”

Section: Methodsmentioning

confidence: 99%

“…Several randomised (Balslev et al, 1982;Gastrointestinal Tumor Study Group, 1985;Fisher et al, 1988) or historically-controlled clinical trials (Tepper et al, 1987;Vigliotti et al, 1987;Mohiuddin et al, 1985) have been concerned with the possible benefit from adjuvant post-operative radiotherapy in this disease. With respect to survival all have come out negative (Bentzen et al, 1988a;Douglass et al, 1986;Fisher et al, 1988): postoperative radiotherapy has not improved survival significantly even when quite substantial numbers of patients are compared. With respect to loco-regional control or disease-free survival diverse conclusions have been reached: in the NSABP study R-01 there was an overall reduction in loco-regional recurrence from 25% to 16% (P = 0.06 (Fisher et al, 1988)), while the GITSG study found no significant reduction in the loco-regional recurrence rate after adjuvant radiotherapy (Gastrointestinal Tumour Study Group, 1985).…”

mentioning

confidence: 99%

“…With respect to loco-regional control or disease-free survival diverse conclusions have been reached: in the NSABP study R-01 there was an overall reduction in loco-regional recurrence from 25% to 16% (P = 0.06 (Fisher et al, 1988)), while the GITSG study found no significant reduction in the loco-regional recurrence rate after adjuvant radiotherapy (Gastrointestinal Tumour Study Group, 1985). One possible explanation is that the very large variability in natural history of colorectal carcinoma (Bentzen et al, 1988a), even within a specific Dukes' stage, might over-shadow the possible benefit from adjuvant therapy (Tannock, 1989;Bentzen et al, 1988a). The present multivariate analysis of clinico-pathological factors affecting the time to locoregional recurrence was undertaken in order to define highrisk subpopulations of patients with Dukes' B and C tumours.…”

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confidence: 99%

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

Bentzen

Balslev²,

Pedersen³

et al. 1992

Br J Cancer

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Summary 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 I 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.

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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?

Cited by 46 publications

References 23 publications

Stromal tenascin distribution as a prognostic marker in colorectal cancer

Stromal tenascin distribution as a prognostic marker in colorectal cancer

The role of perineural invasion in predicting survival in patients with primary operable colorectal cancer: A systematic review

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

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