Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212)

Masayuki Ohue; Shin Fujita; Junki Mizusawa; Yukihide Kanemitsu; Tetsuya Hamaguchi; Shunsuke Tsukamoto; Shingo Noura; Masayoshi Yasui; Masaaki Itoh; Akio Shiomi; Koji Komori; Jun Watanabe; Yoshihiro Akazai; Manabu Shiozawa; Takashi Yamaguchi; Hiroyuki Bandou; Kenji Katsumata; Yoshihiro Moriya

doi:10.1093/jjco/hyab183

Preoperative and postoperative prognostic factors of patients with stage II/III lower rectal cancer without neoadjuvant therapy in the clinical trial (JCOG0212)

Jpn J Clin Oncol. 2022 Feb 5;52(2):114-121. doi: 10.1093/jjco/hyab183.

Authors

Masayuki Ohue¹, Shin Fujita², Junki Mizusawa³, Yukihide Kanemitsu⁴, Tetsuya Hamaguchi⁵, Shunsuke Tsukamoto⁴, Shingo Noura⁶, Masayoshi Yasui¹, Masaaki Itoh⁷, Akio Shiomi⁸, Koji Komori⁹, Jun Watanabe¹⁰, Yoshihiro Akazai¹¹, Manabu Shiozawa¹², Takashi Yamaguchi¹³, Hiroyuki Bandou¹⁴, Kenji Katsumata¹⁵, Yoshihiro Moriya¹⁶

Affiliations

¹ Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan.
² Department of Surgery, Tochigi Cancer Center, Tochigi, Japan.
³ Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
⁴ Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
⁵ Department of Gastroenterological Oncology, International Medical Center, Saitama Medical University, Saitama, Japan.
⁶ Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, Osaka, Japan.
⁷ Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
⁸ Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
⁹ Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
¹⁰ Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Kanagawa, Japan.
¹¹ Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan.
¹² Department of Surgery, Kanagawa Cancer Center, Yokohama, Japan.
¹³ Department of Surgery, Kyoto Medical Center, Kyoto, Japan.
¹⁴ Department of Surgery, Ishikawa Prefectural Central Hospital, Ishikawa, Japan.
¹⁵ Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University Hospital, Tokyo, Japan.
¹⁶ Department of Surgery, Miki Hospital, Iwate, Japan.

Abstract

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: 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: 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: 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.

Keywords: postoperative; preoperative; prognostic factor; rectal cancer; survival.

Publication types

Randomized Controlled Trial

MeSH terms

Disease-Free Survival
Female
Humans
Lymph Node Excision
Lymph Nodes / pathology
Lymph Nodes / surgery
Male
Neoadjuvant Therapy*
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Prospective Studies
Rectal Neoplasms* / drug therapy
Rectal Neoplasms* / surgery
Retrospective Studies

Abstract

Publication types

MeSH terms

Grants and funding