open access

Vol 22, No 5 (2017)
Original research articles
Published online: 2017-09-01
Submitted: 2016-12-28
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Gender-related prognostic significance of clinical and biological tumor features in rectal cancer patients receiving short-course preoperative radiotherapy

Anna Gasinska, Zbigniew Darasz, Agnieszka Adamczyk, Beata Biesaga, Joanna Niemiec, Marian Reinfuss
DOI: 10.1016/j.rpor.2017.07.002
·
Rep Pract Oncol Radiother 2017;22(5):368-377.

open access

Vol 22, No 5 (2017)
Original research articles
Published online: 2017-09-01
Submitted: 2016-12-28

Abstract

Aim

To study the prognostic value of clinical and biological features of rectal cancer and potential gender differences in patients’ overall survival (OS), local recurrence-free survival (RFS) and metastasis-free survival (MFS) after short-course preoperative radiotherapy (SCRT) with short or long interval between RT and surgery (break).

Background

The length of the interval between RT and surgery in SCRT is debatable and gender-related differences in patients survival are not established yet.

Materials and methods

126 patients received SCRT with 5[[ce:hsp sp="0.25"/]]Gy dose per fraction during 5 days, followed by radical surgery after short break ≤17 days, and a long break >17 days. Pretreatment tumor proliferation (bromodeoxyuridine labeling index, BrdUrdLI and S-phase fraction) was evaluated by flow cytometry and proteins: CD34, Ki-67, GLUT-1, Ku70, BCL-2, P53 expression was studied immunohistochemically.

Results

The studied group included 84 men and 42 women. There were 33, 76, and 17 cTNM (AJCC) tumor stages I, II, III, respectively. The median follow-up time was 53.3 months (range 2–142 months). For the whole group Cox multivariate analysis revealed that tumor grade (G[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]1), interval between RT and surgery >17 days, pTNM stage >1 and P53 positivity[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]BrdUrdLI[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]7.9% were negative prognostic factors for OS. Tumor aneuploidy and MVD[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]140.8[[ce:hsp sp="0.25"/]]vessels/mm2 were important for RFS. pTNM stage[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]1 and P53 positivity combined with BrdUrdLI[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]7.9% were risk predictors for MFS. Based on tumor biological features, gender-related difference in OS, RFS, and MFS were observed. In multivariate analysis, male patients age[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]62 years and break >17 days only appeared to be significant for OS.

Conclusions

In male rectal patients treated with SCRT, breaks between RT and surgery >17 days should be avoided because they negatively influence patients’ survival.

Abstract

Aim

To study the prognostic value of clinical and biological features of rectal cancer and potential gender differences in patients’ overall survival (OS), local recurrence-free survival (RFS) and metastasis-free survival (MFS) after short-course preoperative radiotherapy (SCRT) with short or long interval between RT and surgery (break).

Background

The length of the interval between RT and surgery in SCRT is debatable and gender-related differences in patients survival are not established yet.

Materials and methods

126 patients received SCRT with 5[[ce:hsp sp="0.25"/]]Gy dose per fraction during 5 days, followed by radical surgery after short break ≤17 days, and a long break >17 days. Pretreatment tumor proliferation (bromodeoxyuridine labeling index, BrdUrdLI and S-phase fraction) was evaluated by flow cytometry and proteins: CD34, Ki-67, GLUT-1, Ku70, BCL-2, P53 expression was studied immunohistochemically.

Results

The studied group included 84 men and 42 women. There were 33, 76, and 17 cTNM (AJCC) tumor stages I, II, III, respectively. The median follow-up time was 53.3 months (range 2–142 months). For the whole group Cox multivariate analysis revealed that tumor grade (G[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]1), interval between RT and surgery >17 days, pTNM stage >1 and P53 positivity[[ce:hsp sp="0.25"/]]+[[ce:hsp sp="0.25"/]]BrdUrdLI[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]7.9% were negative prognostic factors for OS. Tumor aneuploidy and MVD[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]140.8[[ce:hsp sp="0.25"/]]vessels/mm2 were important for RFS. pTNM stage[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]1 and P53 positivity combined with BrdUrdLI[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]7.9% were risk predictors for MFS. Based on tumor biological features, gender-related difference in OS, RFS, and MFS were observed. In multivariate analysis, male patients age[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]62 years and break >17 days only appeared to be significant for OS.

Conclusions

In male rectal patients treated with SCRT, breaks between RT and surgery >17 days should be avoided because they negatively influence patients’ survival.

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Keywords

BrdUrdLI; P53; Ku70; Rectal cancer; Short-course preoperative radiotherapy; Break in treatment

About this article
Title

Gender-related prognostic significance of clinical and biological tumor features in rectal cancer patients receiving short-course preoperative radiotherapy

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 22, No 5 (2017)

Pages

368-377

Published online

2017-09-01

DOI

10.1016/j.rpor.2017.07.002

Bibliographic record

Rep Pract Oncol Radiother 2017;22(5):368-377.

Keywords

BrdUrdLI
P53
Ku70
Rectal cancer
Short-course preoperative radiotherapy
Break in treatment

Authors

Anna Gasinska
Zbigniew Darasz
Agnieszka Adamczyk
Beata Biesaga
Joanna Niemiec
Marian Reinfuss

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