Predictive factors of oncologic outcome in stage III colon and intra-peritoneal rectal cancer.

Vernes, E. (Elisa) (2013) Predictive factors of oncologic outcome in stage III colon and intra-peritoneal rectal cancer. thesis, Medicine.

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Abstract

Background and Aims: Survival of stage III colorectal cancer (CRC) is variable and difficult to predict. In this context the Lymph Node Ratio (LN Ratio) has been recognized as an important prognostic factor. Hypothesizing that size of the tumor is an important predictive variable, especially when related to LN Ratio, we conducted a retrospective study with the following aims: To identify predictive factors of Overall Survival (OS) and Disease free survival (DFS); to evaluate two ratios including tumor size, the LN Ratio and pT stage as predictive factors; to define, if possible, a population who would benefit from more aggressive adjuvant therapy. Materials and Methods: Stage III CRC patients treated in our department between 2000 and 2010 entered the study. A statistical analysis was performed to identify variables predicting cancer recurrence, OS and DFS. The role of the SLN Ratio (maximum diameter of the tumor divided by the LN Ratio) and SLNT Ratio (maximum diameter of the tumor divided by the product of the LN Ratio and T-stage) was evaluated. A subgroup analysis of predictive factors was performed on patients receiving post-operative chemotherapy. Results: One hundred eighteen patients entered the study. After a median follow-up period of 48 months, 39 patients (33.1%) developed cancer recurrence; the 5-year OS rate was 70.1% and the rate of 5-year DFS was 65.7%. Using univariate analyses, the SLN Ratio lower than 27.083 and the SLNT Ratio lower than 8.889 were significantly related to high risk of cancer recurrence, impaired OS and impaired DFS; however, using a multivariate analysis only male gender, the occurrence of post-operative complications within 30 days from surgery and no adjuvant chemotherapy were predictive variables independently related to a decreased rate of 5-year OS. No independent predictive variables were found for cancer recurrence and 5-year DFS. In a subgroup analysis of patients who underwent post-operative chemotherapy, a SLNT Ratio lower than 8.889 was significantly related to high risk of cancer recurrence, worse rate of 5-year OS (along with young age and male gender) and 5-year DFS (along with male sex), both using univariate and multivariate analyses. Conclusion: The occurrence of post-operative short-term morbidity, male gender and not receiving post-operative chemotherapy represent risk factors for impaired OS. A low SLNT Ratio seems to be a risk factor for impaired oncologic outcome, along with male gender and young age, in patients treated with adjuvant chemotherapy. This population would be in need of more aggressive chemotherapy.

Item Type:	Thesis (Thesis)
Supervisor name:	Nijholt, I.M.
Supervisor name:	Coco, C. and Rizzo, G. and Universita Cattolica del Sacro Cuore and Rome, Italy
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:41
Last Modified:	25 Jun 2020 10:41
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/231

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