Basic Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jun 7, 2007; 13(21): 3009-3015
Published online Jun 7, 2007. doi: 10.3748/wjg.v13.i21.3009
Predicting prognosis of rectal cancer patients with total mesorectal excision using molecular markers
Jun-Jie Peng, San-Jun Cai, Hong-Feng Lu, Guo-Xiang Cai, Peng Lian, Zu-Qing Guan, Ming-He Wang, Ye Xu
Jun-Jie Peng, Ye Xu, Guo-Xiang Cai, Peng Lian, Zu-Qing Guan, Ming-He Wang, San-Jun Cai, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Hong-Feng Lu, Department of Pathology, Cancer Hospital, Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Ye Xu, Department of Abdominal Surgery, Cancer Hospital, Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong’an Road, Shanghai 200032, China. caisanjun@csco.org.cn
Telephone: +86-21-64175590-1208 Fax: +86-21-64035387
Received: March 27, 2007
Revised: April 15, 2007
Accepted: April 26, 2007
Published online: June 7, 2007
Abstract

AIM: To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer.

METHODS: A total of 259 consecutive rectal cancer patients treated with curative total mesorectal excision between 1999 and 2004 were collected. p53, p21, PCNA, and CD44v6 were examined using immunohistochemistry (IHC). The correlation between clinicopathological or molecular variables and clinical outcomes, including local recurrence, metastasis, disease-free survival and overall survival, was analyzed.

RESULTS: The median follow-up was 44 mo. Five-year survival rates and 5-year disease free survival rates were 75.43% and 70.32%, respectively. Multi-analysis revealed TNM staging, preoperative CEA, and CD44v6 level were independent risk factors predicting overall survival or disease free survival. The hazard ratio of peroperative CEA was 2.65 (95% CI 1.4-5) and 3.10 (95% CI 1.37-6.54) for disease free survival and overall survival, respectively. The hazard ratio of CD44v6 was 1.93 (95% CI 1.04-3.61) and 2.21 (95% CI 1.01-4.88) for disease free survival and overall survival, respectively. TNM staging was the only risk factor predicting local recurrence. Postoperative chemotherapy without radiotherapy did not improve patients’ outcome.

CONCLUSION: TNM staging, preoperative CEA and CD44v6 were independent prognostic factors for rectal cancer patients with total mesorectal excision. Postoperative chemotherapy may be only used together with radiotherapy for rectal cancer patients.

Keywords: Rectal cancer; Total mesorectal excision; Immunohistochemistry; Disease free survival; p53; p21; PCNA; CD44v6; CEA; Prognosis