Prognostic value of direct spread in Dukes' C cases of rectal cancer

Abstract

Seventy-six cancers with involved lymph nodes but with limitation of direct spread in continuity to the bowel wall (Astler-Coller C1 cases) were matched with Astler-Coller C2 cases for clinical variables, macroscopic appearance of tumor, grade of differentiation, and number of positive lymph nodes. Despite this stringent matching, spread was shown to be an important prognostic variable in univariate survival analysis. Estimated five-year survival for Astler-Coller C1 cases was just below 80 percent, equivalent to B2 (Dukes' B) cases. When spread was analyzed in the presence of additional prognostic variables (character of invasive margin and lymphocytic infiltration) by multivariate modeling, its independent prognostic status was maintained. Improved survival for C1 cases was not explained by a lower incidence of local pelvic recurrence. Mechanisms to account for the better prognosis are proposed. This study reaffirms the importance of multivariate techniques of analysis in the assessment of prognosis of patients with rectal cancer.

Pathologic determinants of survival associated with colorectal cancer with lymph node metastases. A multivariate analysis of 579 patients

“…In one study using univariate analysis, cal node will vary with the extent of surgery. '6,21,the number of peripheral nodes involved was not significantly related to prognosis, and node level was shown to be of prime imp~rtance. '~ In contrast, using a different definition of node level, Wolmark et aLZ8 found that the level of node involvement contributed little additional information to that provided by the number of involved nodes and the depth of tumor penetration.…”

Preoperative Staging of Rectal Cancer with MR Imaging: Correlation with Surgical and Histopathologic Findings

“…Indeed, the diagnosis of rectal cancer is usually made on the basis of a rectal digital examination, sigmoidoscopy or colonoscopy, a double contrast enema examination, and confirmatory histologic findings (10). However, these approaches do not adequately show the depth of tumor spread or the extent of lymph node involvement, both of which are important prognostic features (11)(12)(13)(14)(15). Preoperative staging techniques for rectal cancer should allow identification of (a) patients with extrarectal spread, who might benefit from preoperative radiation therapy; and (b) patients with minimal or no sphincteral involvement, who might be suitable for sphincter-sparing surgery.…”

In vitro investigation of detectability of colorectal lymph nodes and diagnosis of lymph node metastasis in colorectal cancer using B‐mode sonography

“…The presence and number of involved lymph nodes are strongly related to survival and local recurrence rates. [1][2][3][4][5][6] Currently, postoperative histopathologic examination of resected colorectal lymphatic tissues is the standard means of assessing lymph node status for staging. Although CT and MRI have been investigated as preoperative methods for assessment of lymph node metastasis, these imaging methods do not distinguish between metastatic and nonmetastatic lymph nodes with sufficient accuracy: the sensitivities of both tests are low, although the specificities are high.…”