the significance of histological substaging in curative resected t3 colorectal cancer karl mrak...
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THE SIGNIFICANCE OF HISTOLOGICAL SUBSTAGING IN CURATIVE THE SIGNIFICANCE OF HISTOLOGICAL SUBSTAGING IN CURATIVE
RESECTED T3 COLORECTAL CANCERRESECTED T3 COLORECTAL CANCER
Karl Mrak & Jörg TschmelitschKarl Mrak & Jörg Tschmelitsch
Department of Surgery, Barmherzige Brüder Hospital St. Veit/Glan, AustriaDepartment of Surgery, Barmherzige Brüder Hospital St. Veit/Glan, Austria
BACKGROUND
Depth of infiltration of bowel wall is an important prognostic factor in colo-rectal malignancies. Several studies have shown, that the
pT-stage according to UICC/AJCC influences lymph node involvement, vessel invasion, recurrence and long-term survival. However
there is few data about the role of subgroups within pT-stages particularly in pT3-tumors. The aim of our study was to evaluate
whether depth of infiltration within T3 colorectal tumors influences long term oncologic outcome.
MATERIAL AND METHODS
Patients with pT3, N-/+, M0 colon or rectal cancer who
underwent curative (R0) resection at our department between
January 1991 and December 2003 were collected in a
prospectively maintained cancer database. For our analysis
additional pathologic examinations according to TNM
supplement published by Hermanek P. et al in 1993 were
performed and four subgroups, a through d, based on depth of
microscopic penetration into the subserosa were categorized
(Figure 1). The influence on local recurrence and/or distant
metastasis as well as overall and disease-free survival was
tested for each subgroup and compared in an univariate and
multivariate analysis.
Measuring the maximal tumour invasion beyond the outer border of the muscularis propria
pT3a ≤ 1 mm
pT3b > 1-5 mm
pT3c > 5-15 mm
pT3d > 15 mm
pT3 SUBCLASSIFICATION
MucosaMucosa
SubmucosaSubmucosa
M. propriaM. propria
SubserosaSubserosa
SerosaSerosa Figure 1
RESULTS
Overall 368 patients were evaluated with a median age of 69 years (range 32 – 92) and a median follow-up time of 92.5 months
(range 0 – 196). In 181 patients with colon cancer 5- and 10 years overall survival was 82.7% and 65.0%; 5- and 10 years disease
free survival was 80.9% and 64.4%. For 187 rectal cancer patients 5- and 10 years overall survival was 69.0% and 50.5%; 5- and 10
years disease free survival was 61.3% and 47.5%. The survival rates for pT3 subgroups are shown in Figure 2-5.
Neither in colon nor in rectal cancer different pT3 subgroups showed a statistical significant influence on survival or the occurrence of
local or distant recurrence in univariate and multivariate analyses. However there was a significant influence of higher pT3 subgroups
on lymph node involvement and vessel invasion in rectal cancer patients.
CONCLUSIONS
Subdivision of pT3 tumors in colon cancer, based on depth of infiltration does
not provide us with additional information about prognosis.
In rectal cancer T3 – substages were associated with lymph node
involvement, however we could not show an impact on recurrence or survival.
According to our results in patients with T3 colorectal cancer, prognosis or
treatment decisions cannot be based on pathologic substaging by depth of
infiltration.
LITERATURE
1. Hermanek P, Henson DE, Hutter RVP, Sobin LH, eds. International Union Against Cancer (UICC): TNM Supplement 1993. A commentary on uniform use. Berlin, Heidelberg, New York. Springer Verlag; 1993: 122.
Overall Survival Percentages (Colon)
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10%
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90%
100%
Survival Time [month]0 10 20 30 40 50 60 70 80 90 100 120 140 160 180
pT class 3A 3B 3C 3D
Overall Survival Percentages (Rectum)
0%
10%
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100%
Survival Time [month]0 10 20 30 40 50 60 70 80 90 100 120 140 160 180
pT class 3A 3B 3C 3D
Disease Free Survival Percentages (Colon)
0%
10%
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30%
40%
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80%
90%
100%
Survival Time [month]
0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 160 170 180 190 200
pT class 3A 3B 3C 3D
Disease Free Survival Percentages (Rectum)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Survival Time [month]0 10 20 30 40 50 60 70 80 90 100 120 140 160 180
pT class 3A 3B 3C 3D