Abstract
Purpose
The relationship between the prognosis and the extent of colorectal carcinoma (CRC) is still unclear. As a simple parameter of the local invasion of CRC, we assessed the extent of tumor invasion beyond the outer border of the muscularis propria (MP).
Methods
We examined 147 cases of CRC using a slight modification of the procedure established by the Japanese Society for Cancer of the Colon and Rectum. For the statistical analysis, the patients were divided into two groups, namely, a “shallow” group and a “deep” group, using a specific cut-off value (COV). A multivariate analysis to identify independent prognostic factors was performed.
Results
Significant differences in the 5-year survival rate were observed between the “shallow” and “deep” groups in 39 cases of rectal carcinoma (COV 4 mm; 72.4% vs. 30.0%, hazard ratio = 3.204), but not observed in 147 cases of CRC. In addition, the outcome for patients with “deep” cancer in the lower rectum was markedly worse than that for patients with “shallow” cancer (COV 4 mm; 81.8% vs. 12.5%, hazard ratio = 5.371).
Conclusions
The depth of tumor invasion beyond the MP is thus considered to be an important prognostic factor for patients with T3/T4 rectal carcinoma, especially in the lower rectum. A careful follow-up is required for the patients with rectal carcinoma that has invaded more than 4 mm beyond the MP.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Sobin LH, Wittekind C, editors. TNM classification of malignant tumors. 6th ed. New York: Wiley-Liss; 2002.
Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. 6th ed. Tokyo: Kanehara; 1998.
Japanese Society for Cancer of the Colon and Rectum. General rules for clinical and pathological studies on cancer of the colon, rectum and anus. 7th ed. Tokyo: Kanehara; 2006.
Dukes CE. The classification of cancer of the rectum. J Pathol Bacteriol 1932;35:323–332.
Astler VB, Coller FA. The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 1954;139: 846–852.
Japanese Society for Cancer of the Colon and Rectum. Multi-institutional registry of large bowel cancer in Japan, vol. 26. Cases treated in 1996. Tokyo; 1996.
Kitajima K, Fujimori T, Fujii S, Takeda J, Ohkura Y, Kawamata H, et al. Correlations between lymph node metastasis and depth of submucosal invasion in submucosal invasive colorectal carcinoma: a Japanese collaborative study. J Gastroenterol 2004;39:534–543.
Ueno H, Murphy J, Jass JR, Mochizuki H, Talbot IC. Tumour “budding” as an index to estimate the potential of aggressiveness in rectal cancer. Histopathology 2002;40:127–132
Ueno H, Mochizuki H, Hashiguchi Y, Shimazaki H, Aida S, Hase K, et al. Risk factors for an adverse outcome in early invasive colorectal carcinoma. Gastroenterology 2004;127:385–394.
Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2:996–999.
Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC. Prognostic factors in stage T3N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum 1999;42:167–173.
Picon AI, Moore HG, Sternberg SS, Minsky BD, Paty PB, Blumberg D, et al. Prognostic significance of depth of gross or microscopic perirectal fat invasion in T3 N0 M0 rectal cancers following sharp mesorectal excision and no adjuvant therapy. Int J Colorectal Dis 2003;18:487–492.
Merkel S, Wein A, Gunter K, Papadopoulos T, Hohenberger W, Hermanek P. High-risk groups of patients with stage II colon carcinoma. Cancer 2001;92:1435–1443.
Steel MCA, Woods R, Mackay JM, Chen F. Extent of mesorectal invasion is a prognostic indicator in T3 rectal carcinoma. ANZ J Surg 2002;72:483–487.
Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H, Talbo IC. Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg 2006;243:492–498.
Vass DG, Ainsworth R, Anderson JH, Murray D, Foulis AK. The value of an elastic tissue stain in detecting venous invasion in colorectal cancer. J Clin Pathol 2004;57:769–772.
Shinto E, Ueno H, Hashiguchi Y, Hase K, Tsuda H, Matsubara O, et al. The subserosal elastic lamina: an anatomic landmark for stratifying pT3 colorectal cancer. Dis Colon Rectum 2004; 47:467–473.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Katsumata, D., Fukui, H., Ono, Y. et al. Depth of tumor invasion in locally advanced rectal cancer correlates with patients’ prognosis: The usefulness of elastic stain for its measurement. Surg Today 38, 115–122 (2008). https://doi.org/10.1007/s00595-007-3608-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-007-3608-3