Local recurrence in rectal cancer can be predicted by histopathological factors

Dresen, R.C.; Peters, E.E.M.; Rutten, H.J.T.; Nieuwenhuijzen, G.A.P.; Demeyere, T.B.J.; van den Brule, A.J.C.; Kessels, A.G.H.; Beets-Tan, R.G.H.; van Krieken, J.H.J.M.; Nagtegaal, I.D.

doi:10.1016/j.ejso.2009.03.007

« Previous Next »European Journal of Surgical Oncology
Volume 35, Issue 10 , Pages 1071-1077, October 2009

Local recurrence in rectal cancer can be predicted by histopathological factors

R.C. Dresen
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Corresponding author. Maastricht University Medical Centre, Postbus 5800, 6202 AZ Maastricht, The Netherlands. Tel.: +31 (0)43 387 6910; fax: +31 (0)43 387 6909.
E.E.M. Peters
- Department of Pathology, Radboud University Medical Centre, Geert-Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
H.J.T. Rutten
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
G.A.P. Nieuwenhuijzen
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
T.B.J. Demeyere
- Department of Pathology, PAMM Laboratories, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
A.J.C. van den Brule
- Department of Pathology, PAMM Laboratories, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
A.G.H. Kessels
- Department of Epidemiology, Maastricht University Medical Centre, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
R.G.H. Beets-Tan
- Department of Radiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
J.H.J.M. van Krieken
- Department of Pathology, Radboud University Medical Centre, Geert-Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands
I.D. Nagtegaal
- Department of Pathology, Radboud University Medical Centre, Geert-Grooteplein-Zuid 10, 6525 GA Nijmegen, The Netherlands

Accepted 19 March 2009.

Abstract

Aim

The main cause of local recurrence (LR) in rectal cancer is involvement of the circumferential resection margin (CRM). However, patients with a negative CRM can also develop LR, suggesting that additional factors are important for LR. The aim of this study was to identify histopathological factors predictive for the development of LR after primary rectal cancer treatment.

Methods

T×N×M0 patients treated for locally recurrent rectal cancer at the Catharina hospital from 1994 to 2006 (n=92) were matched with a control group of patients who did not develop LR after primary rectal cancer treatment for at least 2years (n=185) based on the type of neoadjuvant treatment in a 1:2 ratio. The pathology of all primary rectal cancers was reviewed. Patient, treatment and histopathological characteristics were studied in relation to the development of LR with logistic regression.

Results

Logistic regression indicated the presence of lymphovascular invasion (LVI, OR 4.66, P<0.001), extramural venous invasion (EMVI, OR 4.54, P<0.001), positive CRM (OR 2.56, P=0.032), serosal involvement (OR 6.74, P=0.035) and poor differentiation (OR 2.59, P=0.012) as factors with an increased risk to develop LR. Older age was a protective factor (OR 0.95, CI 0.93–0.98, P=0.001).

Conclusion

Apart from a positive CRM and serosal involvement, LVI, EMVI and poor differentiation are important independent predictive factors for the development of LR. Adjuvant therapy may be considered in the presence of these features in order to decrease the risk of a local recurrence.

Keywords: Rectal cancer, Histopathology, Local recurrence, Extramural venous invasion, Lymphovascular invasion