Extent of Mesorectal Tumor Invasion as a Prognostic Factor After Curative Surgery for T3 Rectal Cancer Patients

Miyoshi, Masayoshi; Ueno, Hideki; Hashiguchi, Yojiro; Mochizuki, Hidetaka; Talbot, Ian C.

doi:10.1097/01.sla.0000205627.05769.08

Cited by 63 publications

(39 citation statements)

References 27 publications

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“…On the other hand, there were no differences in the recurrence sites after surgery for patients with T3 and T2 stage III rectal cancer. It is thought that tumors at opposite ends of the T3 spectrum may have very different prognostic implications [18]. Recent studies reported the circumferential resectional margin to be important [19] and the extent of mesorectal tumor invasion to be an independent factor predicting the overall survival of T3 rectal cancer patients after curative surgery[18].…”

Section: Discussionmentioning

confidence: 99%

“…It is thought that tumors at opposite ends of the T3 spectrum may have very different prognostic implications [18]. Recent studies reported the circumferential resectional margin to be important [19] and the extent of mesorectal tumor invasion to be an independent factor predicting the overall survival of T3 rectal cancer patients after curative surgery[18]. It is therefore suggested that survival in patients with T3 stage III rectal cancer is worse than that in patients with T2 stage III rectal cancer.…”

Section: Discussionmentioning

confidence: 99%

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Survival of Patients with T3 Stage III Rectal Cancer Is Significantly Worse than T2 Stage III Rectal Cancer

Hotta¹,

Takifuji²,

Yokoyama³

et al. 2009

Dig Surg

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Background: The prognosis of T1 plus T2 stage III rectal cancer patients is better than that of T3 stage III rectal cancer patients. However, it is thought that T1 rectal cancer patients have a better prognosis than T2 rectal cancer patients. Aim: This study attempted to clarify the difference of the short- and long-term outcomes in T2 and T3 stage III rectal cancer patients deleting T1 cancer. Methods: The study demonstrated the potential predictors of the survival after surgery, the factors associated with T3 and T2, and the recurrence sites in 134 patients with stage III rectal cancer who underwent surgery, including 111 patients with T3 and 23 patients with T2. Results: The disease-free survival (DFS) of the T3 stage III patients was worse than the T2 stage III patients (5-year DFS rates, 52 vs. 78%; 10-year DFS rates, 43 vs. 78%; p =0.044). The maximum tumor size and operative blood loss were significant tumor characteristics associated with the depth of invasion (p =0.007,p =0.011,respectively). There was no significant difference in the recurrence sites after surgery between the two groups. Conclusion: As a result, a more detailed subdivision for stage III rectal cancer is considered necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survival of Patients with T3 Stage III Rectal Cancer Is Significantly Worse than T2 Stage III Rectal Cancer

Hotta¹,

Takifuji²,

Yokoyama³

et al. 2009

Dig Surg

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“…A study conducted by Merket et al in 2001 showed a 5-year survival rate for the early-staged tumor patients DME < 5 mm (T3ab) was 85% -90% and for advanced tumor DME > 5 mm (T3cd) was only 54%. Many other studies analyzed the impact of extramural spread (< 5 mm and > 5 mm) with respect to the survival rate in patients with no neoadjuvant chemo therapy or preoperative radiotherapy (6,10). Other studies have also analyzed the impact of extramural spread with respect to the survival rate in patients with neoadjuvant chemotherapy and preoperative radiotherapy (8,25).…”

Section: Re-categorization Of T3 Sub-stagingmentioning

confidence: 99%

“…Many previous studies investigated the prognosis of T3 subdivision using various cutoff points (4 mm, 5 mm, and 6 mm) and came to conclusion that the deeper the tumor invasion, the worst the prognosis (9,10). Recently, using 5 mm as a cutoff point to differentiate early and advanced T3 rectal cancer is highly acceptable.…”

Section: Introductionmentioning

confidence: 99%

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

et al. 2018

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Background: MRI predicted distance of mesorectal extension (mrDME) in rectal cancer is one of the independent risk factors for recurrence and poor overall survival. In T3 rectal cancer, if no lymph node or distant metastasis is seen, the selection of optimum treatment is based on the distance of mesorectal extension. Therefore, it is very crucial to investigate the reproducibility of DME in T3 rectal cancer. Objectives: To investigate the reproducibility of the distance of mesorectal extension by tumor invasion in T3 stage rectal cancer by evaluating sub-stages T3a, T3b T3c and T3d individually versus T3a, T3b (T3ab) and T3c, T3d (T3cd) combined together using MRI. Methods: From July 2014 to December 2015, 188 patients with surgically and histologically confirmed T3 rectal cancer who underwent preoperative MRI were enrolled into this study. Two blinded radiologists evaluated the maximum distance of mesorectal extension (mrDME) in T2 weighted image in MRI. The study population was sub classified into T3a (< 1 mm), T3b (1 -5 mm), T3c (5 -15 mm) and T3d (> 15 mm) according to the distance of mesorectal extension by tumor invasion. The inter-observer and intra-observer data were then assessed using Kappa analysis (k); intraclass correlation coefficients (ICC) were also analyzed subsequently. Results: Difference in the value of inter/intra observer kappa (k), and inter/intra-observer intraclass coefficients (ICC) between the two groups was very distinct. In the individual group (T3a, T3b, T3c and T3d), the inter-observer and intra-observer (k) for the mrDME was 0.700 and 0.718 respectively; the inter-observer and intra-observer ICC was 0.772 and 0.786 respectively. In the combined group (T3ab and T3cd), the inter-observer and intra-observer kappa (k) for the mrDME was 0.819 and 0.883 respectively; the inter-observer and intra-observer ICC was 0.829 and 0.796 respectively. Conclusions: There was a distinct increase in the kappa (K) and intraclass coefficient (ICC) value in the combined group compared with the individual group. This high reproducibility result suggested that it is more reliable to measure T3ab and T3cd combined together than individually. This finding can play a crucial role in the management of rectal cancer and clinical decision making for non-expert radiologists in non-academic setting.

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“…It is proposed that T3 patients with early microinvasion do not require neoadjuvant chemotherapy (7,8). Many studies have found that the extent of mesorectal invasion (EMI) is a significant independent prognostic factor for T3 rectal cancer (9)(10)(11)(12). The MERCURY study showed that rectal cancer patients with an EMI ≤5 mm (pT3a) had a better prognosis than those with an EMI >5 mm (pT3b) (13).…”

Section: Introductionmentioning

confidence: 99%

Value of endorectal ultrasonography in measuring the extent of mesorectal invasion and substaging of T3 stage rectal cancer

et al. 2017

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Abstract. The present study aimed to determine the value of endorectal ultrasound (ERUS) and magnetic resonance imaging (MRI) for T3 rectal cancer, and substaging of T3 rectal cancer by measuring the extent of mesorectal invasion (EMI). The clinical data of patients with rectal cancer who were admitted to the general surgical department of Peking Union Medical College Hospital (Beijing, China) were reviewed and analyzed. Two ultrasound practitioners independently measured the EMI on ERUS, and a radiologist measured the EMI on MRI. The consistency of ERUS measurements between the two doctors was assessed using intraclass consistency (ICC) analysis. T3 stages were subdivided into T3a (EMI ≤5 mm) and uT3b (EMI >5 mm). The accuracy of MRI and ERUS in T3 rectal cancer, and T3 substaging of rectal cancer was assessed and compared according to the pathological results. The Bland-Altman scatter plot demonstrated good consistency between the ERUS measurement and pathology measurement. Furthermore, the consistency of the ERUS measurement between the two doctors was good (ICC, 0.9344; 95% confidence interval, 0.8789-0.9645). The diagnostic accuracies for T3 rectal cancer, for the two ultrasound doctors and for MRI were 86.9% (53/61), 85.2% (52/61), and 90.2% (55/61), respectively. The accuracy, sensitivity and specificity for the two individual ultrasound doctors in the substaging of T3 tumors were 79.1% (34/43), 66.7% (10/15), and 85.7% (24/28), compared with 67.4% (31/43), 60% (9/15), and 82.1% (23/28), respectively. The accuracy of MRI in the substaging of T3 tumors was 86.0% (37/43), which was not statistically higher compared with those of ERUS (P>0.05). In conclusion, ERUS is a valuable tool for measuring the EMI and substaging T3 rectal cancer, and thus, can be complementary to MRI in selecting the appropriate treatment for rectal cancer.

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Extent of Mesorectal Tumor Invasion as a Prognostic Factor After Curative Surgery for T3 Rectal Cancer Patients

Abstract: Extent of mesorectal invasion, based on a 6-mm cutoff value, is useful for subclassification of T3 rectal cancer patients.

Cited by 63 publications

References 27 publications

Survival of Patients with T3 Stage III Rectal Cancer Is Significantly Worse than T2 Stage III Rectal Cancer

Survival of Patients with T3 Stage III Rectal Cancer Is Significantly Worse than T2 Stage III Rectal Cancer

Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI

Value of endorectal ultrasonography in measuring the extent of mesorectal invasion and substaging of T3 stage rectal cancer

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