01.12.2017 | Research article | Ausgabe 1/2017 Open Access

Patients with pathological stage N2 rectal cancer treated with early adjuvant chemotherapy have a lower treatment failure rate
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Patients and patient workup
Treatment
Follow-up
Statistical analysis
Results
Patient characteristics
Characteristics
|
A-CRT group (
n = 71)
|
A-CT group (
n = 43)
|
p
|
---|---|---|---|
Sex
|
0.426
|
||
Men
|
47 (66.2)
|
26 (60.5)
|
|
Women
|
24 (33.8)
|
17 (39.5)
|
|
Age(years)
|
0. 261
|
||
Median
|
54
|
52
|
|
Range
|
32-73
|
23-70
|
|
Distance from anal verge (cm)
|
0.773
|
||
≤ 5 cm
|
25 (35.2)
|
11 (25.6)
|
|
> 5 cm
|
46 (64.8)
|
32 (74.4)
|
|
Karnofsky Performance Score
|
0.464
|
||
≥ 90
|
36 (50.7)
|
25 (58.1)
|
|
<90
|
35 (49.3)
|
18 (41.9)
|
|
pT category
|
0.062
|
||
T2
|
4 (5.6)
|
3 (7.0)
|
|
T3
|
64 (90.1)
|
32 (74.4)
|
|
T4
|
3 (4.2)
|
8 (18.6)
|
|
TNM stage
|
0.049
|
||
IIIB
|
40 (56.3)
|
15 (34.9)
|
|
IIIC
|
31 (43.7)
|
28 (65.1)
|
|
Surgery
|
0.438
|
||
Low anterior resection
|
54 (76.1)
|
35 (81.4)
|
|
Abdominoperineal resection
|
17 (23.9)
|
7 (16.3)
|
|
Hartmann
|
0 (0.0)
|
1 (2.3)
|
|
Lymphovascular invasion
|
0.125
|
||
Yes
|
15 (21.1)
|
13 (30.2)
|
|
No
|
56 (78.9)
|
30 (69.8)
|
|
Tumor deposits
|
0.049
|
||
Yes
|
11 (15.5)
|
12 (27.9)
|
|
No
|
60 (84.5)
|
31 (72.1)
|
|
Number of nodes retrieved
|
0.080
|
||
Median
|
17
|
20
|
|
Range
|
6-51
|
8-41
|
|
Number of positive nodes
|
0.050
|
||
Median
|
6
|
7
|
|
Range
|
4-29
|
4-26
|
|
Radiation dose
|
>0.999
|
||
≥ 45Gy
|
70 (93.6)
|
43 (100.0)
|
|
<45Gy
|
1 (1.4)
|
0 (0.0)
|
|
Concurrent chemotherapy
|
0.226
|
||
Full dose
|
66 (93.0)
|
37 (86.0)
|
|
Reduced dose
|
5 (7.0)
|
6 (14.0)
|
|
Time to adjuvant treatment (wk)
|
<0.001
|
||
Median
|
6.6
|
4.3
|
|
Range
|
3.6-14.0
|
1.9-16.1
|
|
Time to adjuvant radiotherapy (wk)
|
<0.001
|
||
Median
|
6.6
|
17.1
|
|
Range
|
3.6-14.0
|
5.1-35.4
|
|
Time to adjuvant chemotherapy (wk)
|
<0.001
|
||
Median
|
15.6
|
4.3
|
|
Range
|
4.6-23.9
|
1.9-16.1
|
Failure pattern
Sites of recurrence
|
A-CRT group
|
A-CT group
|
p
|
||
---|---|---|---|---|---|
n
|
%
|
n
|
%
|
||
Total no. of recurrence
|
24
|
33.8
|
7
|
16.3
|
0.042
|
No. of locoregional recurrence
|
4
|
5.6
|
1
|
2.3
|
0.647
|
No. of distant metastasis
|
23
|
32.4
|
6
|
14.3
|
0.028
|
All site of distant metastasis
|
|||||
Lung
|
14
|
3
|
|||
Liver
|
7
|
1
|
|||
Bone
|
3
|
1
|
|||
Non-regional lymph nodes
|
3
|
1
|
|||
Peritoneal seeding
|
2
|
1
|
Survival
Item
|
n
|
3y-OS
|
3y-DFS
|
3y-LRFS
|
3y-DMFS
|
||||
---|---|---|---|---|---|---|---|---|---|
%
|
P
|
%
|
P
|
%
|
P
|
%
|
P
|
||
Sex
|
|||||||||
Men
|
73
|
86.0
|
0.983
|
75.1
|
0.831
|
95.3
|
0.980
|
73.9
|
0.970
|
Women
|
41
|
82.8
|
68.7
|
93.9
|
74.7
|
||||
Age(years)
|
|||||||||
<60
|
91
|
86.5
|
0.533
|
71.1
|
0.280
|
95.2
|
0.943
|
73.0
|
0.321
|
≥ 60
|
23
|
75.5
|
75.2
|
92.3
|
75.2
|
||||
Distance from anal verge (cm)
|
|||||||||
≤ 5
|
36
|
81.8
|
0.884
|
65.0
|
0.247
|
92.5
|
0.756
|
68.0
|
0.364
|
> 5
|
78
|
85.7
|
75.9
|
96.0
|
76.8
|
||||
pT category
|
|||||||||
T2
|
7
|
100.0
|
0.223
|
68.6
|
0.908
|
100.0
|
0.744
|
68.6
|
0.892
|
T3
|
96
|
85.5
|
71.6
|
94.2
|
73.4
|
||||
T4
|
11
|
60.6
|
85.7
|
100.0
|
85.7
|
||||
TNM stage
|
|||||||||
IIIB
|
55
|
88.6
|
0.262
|
72.9
|
0.675
|
97.4
|
0.143
|
71.4
|
0.845
|
IIIC
|
59
|
81.2
|
72.2
|
92.3
|
76.8
|
||||
Lymphovascular invasion
|
|||||||||
No
|
86
|
85.8
|
0.124
|
78.2
|
0.013
|
93.4
|
0.819
|
80.2
|
0.027
|
Yes
|
28
|
82.2
|
54.8
|
100.0
|
54.8
|
||||
Tumor deposits
|
|||||||||
No
|
91
|
88.7
|
0.008
|
75.3
|
0.258
|
96.4
|
0.190
|
74.3
|
0.517
|
Yes
|
23
|
71.3
|
61.3
|
88.4
|
72.8
|
||||
Number of nodes retrieved
|
|||||||||
<12
|
10
|
77.8
|
0.066
|
36.0
|
0.002
|
100.0
|
0.446
|
36.0
|
0.001
|
≥ 12
|
104
|
85.2
|
76.5
|
94.3
|
78.2
|
||||
Sequence
|
|||||||||
A-CRT
|
71
|
81.8
|
0.379
|
66.7
|
0.153
|
93.7
|
0.629
|
67.5
|
0.074
|
A-CT
|
43
|
90.8
|
83.9
|
97.4
|
86.6
|
Endpoint
|
Item
|
HR
|
95% CI
|
p
|
---|---|---|---|---|
OS
|
Lymphovascular invasion (Yes vs No)
|
3.376
|
1.043-10.929
|
0.042
|
Tumor deposits (Yes vs No)
|
4.604
|
1.516-13.976
|
0.007
|
|
DFS
|
Age (years)
|
0.961
|
0.929-0.995
|
0.026
|
A-CT vs. A-CRT
|
0.345
|
0.137-0.868
|
0.024
|
|
Lymphovascular invasion (Yes vs No)
|
3.324
|
1.520-7.269
|
0.003
|
|
DMFS
|
A-CT vs. A-CRT
|
0.366
|
0.143-0.938
|
0.036
|
Lymphovascular invasion (Yes vs No)
|
2.928
|
1.359-6.309
|
0.006
|
|
Number of nodes retrieved
|
0.945
|
0.897-0.997
|
0.037
|