Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy

David Stewart, Y. Yan, M. Mutch, I. Kodner, S. Hunt, J. Lowney, E. Birnbaum, T. Read, J. Fleshman, D. Dietz

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: To identify the factors that affect the disease-free survival (DFS) of rectal cancer patients. Method: Patients from an IRB approved rectal cancer database were reviewed (1990-2000). All patients underwent either abdominoperineal resection or low anterior resection using total mesorectal excision with curative intent. Univariate and multivariate analyses were performed to analyse the factors that influenced DFS. Results: A total of 304 patients were reviewed (mean age 64, 52% male). Seventy-seven per cent of patients received neoadjuvant therapy (28.6% short-course radiation therapy (RT), 35.5% long-course RT, 12.5% chemo-RT). The radial margin was involved with tumour in 5.2% of patients (final pathology). The overall survival rate was 85.2% with a mean follow-up time of 33 ± 26 months. The mean time to death was 34.8 ±26.8 months. Local recurrence (± distant recurrence) occurred in 4%. Anastomotic leaks occurred in 3.6% of patients. Overall pathologic stage, pathologic T stage, nodal status, the use of adjuvant chemotherapy, tumour fixation, involvement of the radial margin, the presence of mucin, and lymphatic and perineural invasion (PNI) were predictors of DFS by univariate analysis. Of note, anastomotic leaks and obstructing cancers did not influence DFS. Using multivariate analysis with backward elimination, overall pathologic stage, radial margin status, adjuvant chemotherapy, and PNI predicted the DFS. Conclusion: Major predictors of DFS in rectal cancer are the overall pathologic stage, adjuvant chemotherapy, radial margin status and PNI. Radial margin status may be a marker of tumour aggressiveness and should be considered in deciding on adjuvant chemotherapy.

Original languageEnglish (US)
Pages (from-to)879-886
Number of pages8
JournalColorectal Disease
Volume10
Issue number9
DOIs
StatePublished - Nov 4 2008

Fingerprint

Rectal Neoplasms
Disease-Free Survival
Adjuvant Chemotherapy
Anastomotic Leak
Radiotherapy
Multivariate Analysis
Recurrence
Neoplasms
Neoadjuvant Therapy
Research Ethics Committees
Mucins
Survival Analysis
Tumor Biomarkers
Statistical Factor Analysis
Survival Rate
Databases
Pathology

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Stewart, D., Yan, Y., Mutch, M., Kodner, I., Hunt, S., Lowney, J., ... Dietz, D. (2008). Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy. Colorectal Disease, 10(9), 879-886. https://doi.org/10.1111/j.1463-1318.2008.01508.x
Stewart, David ; Yan, Y. ; Mutch, M. ; Kodner, I. ; Hunt, S. ; Lowney, J. ; Birnbaum, E. ; Read, T. ; Fleshman, J. ; Dietz, D. / Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy. In: Colorectal Disease. 2008 ; Vol. 10, No. 9. pp. 879-886.
@article{37ebec37c6d94472901b8e3e1428fa50,
title = "Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy",
abstract = "Objective: To identify the factors that affect the disease-free survival (DFS) of rectal cancer patients. Method: Patients from an IRB approved rectal cancer database were reviewed (1990-2000). All patients underwent either abdominoperineal resection or low anterior resection using total mesorectal excision with curative intent. Univariate and multivariate analyses were performed to analyse the factors that influenced DFS. Results: A total of 304 patients were reviewed (mean age 64, 52{\%} male). Seventy-seven per cent of patients received neoadjuvant therapy (28.6{\%} short-course radiation therapy (RT), 35.5{\%} long-course RT, 12.5{\%} chemo-RT). The radial margin was involved with tumour in 5.2{\%} of patients (final pathology). The overall survival rate was 85.2{\%} with a mean follow-up time of 33 ± 26 months. The mean time to death was 34.8 ±26.8 months. Local recurrence (± distant recurrence) occurred in 4{\%}. Anastomotic leaks occurred in 3.6{\%} of patients. Overall pathologic stage, pathologic T stage, nodal status, the use of adjuvant chemotherapy, tumour fixation, involvement of the radial margin, the presence of mucin, and lymphatic and perineural invasion (PNI) were predictors of DFS by univariate analysis. Of note, anastomotic leaks and obstructing cancers did not influence DFS. Using multivariate analysis with backward elimination, overall pathologic stage, radial margin status, adjuvant chemotherapy, and PNI predicted the DFS. Conclusion: Major predictors of DFS in rectal cancer are the overall pathologic stage, adjuvant chemotherapy, radial margin status and PNI. Radial margin status may be a marker of tumour aggressiveness and should be considered in deciding on adjuvant chemotherapy.",
author = "David Stewart and Y. Yan and M. Mutch and I. Kodner and S. Hunt and J. Lowney and E. Birnbaum and T. Read and J. Fleshman and D. Dietz",
year = "2008",
month = "11",
day = "4",
doi = "10.1111/j.1463-1318.2008.01508.x",
language = "English (US)",
volume = "10",
pages = "879--886",
journal = "Colorectal Disease",
issn = "1462-8910",
publisher = "Wiley-Blackwell",
number = "9",

}

Stewart, D, Yan, Y, Mutch, M, Kodner, I, Hunt, S, Lowney, J, Birnbaum, E, Read, T, Fleshman, J & Dietz, D 2008, 'Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy', Colorectal Disease, vol. 10, no. 9, pp. 879-886. https://doi.org/10.1111/j.1463-1318.2008.01508.x

Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy. / Stewart, David; Yan, Y.; Mutch, M.; Kodner, I.; Hunt, S.; Lowney, J.; Birnbaum, E.; Read, T.; Fleshman, J.; Dietz, D.

In: Colorectal Disease, Vol. 10, No. 9, 04.11.2008, p. 879-886.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of disease-free survival in rectal cancer patients undergoing curative proctectomy

AU - Stewart, David

AU - Yan, Y.

AU - Mutch, M.

AU - Kodner, I.

AU - Hunt, S.

AU - Lowney, J.

AU - Birnbaum, E.

AU - Read, T.

AU - Fleshman, J.

AU - Dietz, D.

PY - 2008/11/4

Y1 - 2008/11/4

N2 - Objective: To identify the factors that affect the disease-free survival (DFS) of rectal cancer patients. Method: Patients from an IRB approved rectal cancer database were reviewed (1990-2000). All patients underwent either abdominoperineal resection or low anterior resection using total mesorectal excision with curative intent. Univariate and multivariate analyses were performed to analyse the factors that influenced DFS. Results: A total of 304 patients were reviewed (mean age 64, 52% male). Seventy-seven per cent of patients received neoadjuvant therapy (28.6% short-course radiation therapy (RT), 35.5% long-course RT, 12.5% chemo-RT). The radial margin was involved with tumour in 5.2% of patients (final pathology). The overall survival rate was 85.2% with a mean follow-up time of 33 ± 26 months. The mean time to death was 34.8 ±26.8 months. Local recurrence (± distant recurrence) occurred in 4%. Anastomotic leaks occurred in 3.6% of patients. Overall pathologic stage, pathologic T stage, nodal status, the use of adjuvant chemotherapy, tumour fixation, involvement of the radial margin, the presence of mucin, and lymphatic and perineural invasion (PNI) were predictors of DFS by univariate analysis. Of note, anastomotic leaks and obstructing cancers did not influence DFS. Using multivariate analysis with backward elimination, overall pathologic stage, radial margin status, adjuvant chemotherapy, and PNI predicted the DFS. Conclusion: Major predictors of DFS in rectal cancer are the overall pathologic stage, adjuvant chemotherapy, radial margin status and PNI. Radial margin status may be a marker of tumour aggressiveness and should be considered in deciding on adjuvant chemotherapy.

AB - Objective: To identify the factors that affect the disease-free survival (DFS) of rectal cancer patients. Method: Patients from an IRB approved rectal cancer database were reviewed (1990-2000). All patients underwent either abdominoperineal resection or low anterior resection using total mesorectal excision with curative intent. Univariate and multivariate analyses were performed to analyse the factors that influenced DFS. Results: A total of 304 patients were reviewed (mean age 64, 52% male). Seventy-seven per cent of patients received neoadjuvant therapy (28.6% short-course radiation therapy (RT), 35.5% long-course RT, 12.5% chemo-RT). The radial margin was involved with tumour in 5.2% of patients (final pathology). The overall survival rate was 85.2% with a mean follow-up time of 33 ± 26 months. The mean time to death was 34.8 ±26.8 months. Local recurrence (± distant recurrence) occurred in 4%. Anastomotic leaks occurred in 3.6% of patients. Overall pathologic stage, pathologic T stage, nodal status, the use of adjuvant chemotherapy, tumour fixation, involvement of the radial margin, the presence of mucin, and lymphatic and perineural invasion (PNI) were predictors of DFS by univariate analysis. Of note, anastomotic leaks and obstructing cancers did not influence DFS. Using multivariate analysis with backward elimination, overall pathologic stage, radial margin status, adjuvant chemotherapy, and PNI predicted the DFS. Conclusion: Major predictors of DFS in rectal cancer are the overall pathologic stage, adjuvant chemotherapy, radial margin status and PNI. Radial margin status may be a marker of tumour aggressiveness and should be considered in deciding on adjuvant chemotherapy.

UR - http://www.scopus.com/inward/record.url?scp=54949098890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=54949098890&partnerID=8YFLogxK

U2 - 10.1111/j.1463-1318.2008.01508.x

DO - 10.1111/j.1463-1318.2008.01508.x

M3 - Article

C2 - 19037929

AN - SCOPUS:54949098890

VL - 10

SP - 879

EP - 886

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 9

ER -