Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212).
postoperative
preoperative
prognostic factor
rectal cancer
survival
Journal
Japanese journal of clinical oncology
ISSN: 1465-3621
Titre abrégé: Jpn J Clin Oncol
Pays: England
ID NLM: 0313225
Informations de publication
Date de publication:
05 Feb 2022
05 Feb 2022
Historique:
received:
27
03
2021
accepted:
09
11
2021
pubmed:
6
12
2021
medline:
11
2
2022
entrez:
5
12
2021
Statut:
ppublish
Résumé
The JCOG0212 trial was a randomized controlled trial comparing mesorectal excision alone to mesorectal excision with lateral lymph node dissection for stage II/III lower rectal cancer patients without clinical lateral lymph node enlargement. This study aimed to identify clinicopathological prognostic factors for relapse-free survival and overall survival of lower rectal cancer in the trial. Prospective data were selected from 663 patients with complete data. Uni and multivariable Cox regression model was applied to evaluate the preoperative and the combined preoperative and postoperative factors, respectively. Preoperative factors included age, sex, performance status, clinical T, clinical N and operative procedures. Postoperative factors included histological grade, pathological T, number of metastatic lymph nodes and number of dissected lymph nodes. No patient received neoadjuvant treatment. Regarding preoperative factors, multivariable analysis revealed that performance status 1 (vs. 0: HR 2.079, P = 0.0041) and cT4a (vs. cT2-3: HR 2.721, P = 0.0002) were independent risk factors for relapse-free survival, and those for overall survival were male (vs. female: HR 1.660, P = 0.0228) and cT4a (vs. cT2-3: HR 2.486, P = 0.0473). The only independent preoperative risk factor common for relapse-free survival and overall survival was cT4a. Taking preoperative and postoperative factors together, the number of metastatic lymph nodes was the only independent risk factor common for relapse-free survival and overall survival. Clinical stage II/III lower rectal cancer patients with cT4a should be a target of therapeutic development of neoadjuvant therapy. Postoperatively, intensive chemotherapy should be investigated for patients with more metastatic lymph nodes.
Sections du résumé
BACKGROUND
BACKGROUND
The JCOG0212 trial was a randomized controlled trial comparing mesorectal excision alone to mesorectal excision with lateral lymph node dissection for stage II/III lower rectal cancer patients without clinical lateral lymph node enlargement. This study aimed to identify clinicopathological prognostic factors for relapse-free survival and overall survival of lower rectal cancer in the trial.
METHODS
METHODS
Prospective data were selected from 663 patients with complete data. Uni and multivariable Cox regression model was applied to evaluate the preoperative and the combined preoperative and postoperative factors, respectively. Preoperative factors included age, sex, performance status, clinical T, clinical N and operative procedures. Postoperative factors included histological grade, pathological T, number of metastatic lymph nodes and number of dissected lymph nodes. No patient received neoadjuvant treatment.
RESULTS
RESULTS
Regarding preoperative factors, multivariable analysis revealed that performance status 1 (vs. 0: HR 2.079, P = 0.0041) and cT4a (vs. cT2-3: HR 2.721, P = 0.0002) were independent risk factors for relapse-free survival, and those for overall survival were male (vs. female: HR 1.660, P = 0.0228) and cT4a (vs. cT2-3: HR 2.486, P = 0.0473). The only independent preoperative risk factor common for relapse-free survival and overall survival was cT4a. Taking preoperative and postoperative factors together, the number of metastatic lymph nodes was the only independent risk factor common for relapse-free survival and overall survival.
CONCLUSIONS
CONCLUSIONS
Clinical stage II/III lower rectal cancer patients with cT4a should be a target of therapeutic development of neoadjuvant therapy. Postoperatively, intensive chemotherapy should be investigated for patients with more metastatic lymph nodes.
Identifiants
pubmed: 34865105
pii: 6446273
doi: 10.1093/jjco/hyab183
pmc: PMC9055856
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
114-121Subventions
Organisme : National Cancer Center Research and Development Funds
ID : 23-A-16
Organisme : Grants-in-Aid for Cancer Research
ID : 14S-4
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Références
N Engl J Med. 2004 Oct 21;351(17):1731-40
pubmed: 15496622
Lancet. 1986 Jun 28;1(8496):1479-82
pubmed: 2425199
Br J Surg. 2020 Apr;107(5):586-594
pubmed: 32162301
Colorectal Dis. 2013 Nov;15(11):1333-42
pubmed: 23758978
Ann Surg. 2012 Jun;255(6):1129-34
pubmed: 22549752
Lancet Oncol. 2021 Jan;22(1):29-42
pubmed: 33301740
Br J Surg. 2007 Aug;94(8):1014-9
pubmed: 17436337
J Surg Oncol. 2016 May;113(6):692-9
pubmed: 26914147
Ann Surg. 2017 Aug;266(2):201-207
pubmed: 28288057
Lancet Oncol. 2021 May;22(5):702-715
pubmed: 33862000
J Clin Oncol. 2019 Dec 1;37(34):3212-3222
pubmed: 31150315
Int J Clin Oncol. 2020 Jan;25(1):1-42
pubmed: 31203527
Langenbecks Arch Surg. 2006 Sep;391(5):449-54
pubmed: 16847648
Ann Surg. 2016 Apr;263(4):751-60
pubmed: 25822672
Br J Surg. 1996 Jun;83(6):781-5
pubmed: 8696739
Dis Colon Rectum. 2006 Nov;49(11):1663-72
pubmed: 17041749