Towards a 'Lyon molecular signature' to individualize the treatment of rectal cancer. Prognostic analysis of a prospective cohort of 94 rectal cancers T1-2-3 Nx MO to be the basis of a molecular signature
| Autor: | Pascale Romestaing, Jérôme Doyen, J. Baulieux, Jean-Pierre Gerard, Jocelyn Gal, Olivier Chapet, Sylviane Olschwang, Eric Letouzé |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Oncology medicine.medical_specialty Multivariate analysis Colorectal cancer medicine.medical_treatment Risk Assessment Concurrent chemotherapy Internal medicine medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies External beam radiotherapy Neoplasm Metastasis Stage (cooking) Prospective cohort study Aged Neoplasm Staging Aged 80 and over Rectal Neoplasms business.industry Carcinoma Middle Aged Radiotherapy alone Prognosis medicine.disease Neoadjuvant Therapy Surgery Radiation therapy Chemotherapy Adjuvant Multivariate Analysis Female Radiotherapy Adjuvant Neoplasm Recurrence Local business |
| Zdroj: | Cancer/Radiothérapie. 16:688-696 |
| ISSN: | 1278-3218 |
| Popis: | Purpose In 1998 a translational research was initiated in Lyon aiming at identifying a prognostic “biomolecular signature” in rectal cancer. This paper presents the clinical outcome of the patients included in this study. Patients and methods A total of 94 patients were included between 1998 and 2001. A staging with rectoscopy and biopsies was performed before treatment. In case of surgery, the operative specimen was analysed to evaluate the pathological response. There were two types of treatment: neoadjuvant radiotherapy (with or without concurrent chemotherapy) followed by surgery (76 cases) and radiotherapy alone with ‘contactherapy’ often associated with external beam radiotherapy (18 patients). Results The patients had a mean age of 63 years. Stage was T1: 4, T2: 24, T3: 65 and T4: 1. The overall survival of the 94 patients was 62% at 8 years with a rate of distant metastases of 29%. Rate of local recurrence at 8 years was 6% in the neoadjuvant group and 16% in the radiotherapy group with an overall 8 years survival in both groups respectively: 64% and 53%. There was a trend towards more metastases in cT3, tumour diameter above 4 cm, circumferential extension. There was a significant increase in the risk of metastases for ypT3, ypN1-2 and Dworak score 1-2-3. In multivariate analysis ypT3 was significantly associated with a high rate of metastases (55%; P = 0.0003). Conclusion The rate of distant metastases is a major prognostic factor. These clinical results will serve as the base line to identify a “biomolecular signature” which could complement the TN(M) classification. |
| Databáze: | OpenAIRE |
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