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KMID : 0859320060240040255
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Journal of the Korean Society for Therapeutic Radiology and Oncology
2006 Volume.24 No. 4 p.255 ~ p.262
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The Clinicopathological Factors That Determine a Local Recurrence of Rectal Cancers That Have Been Treated with Surgery and Chemoradiotherapy
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Choi Chul-Won
Kim Mi-Sook
Cho Chul-Koo
Yoo Seong-Yul
Yang Kwang-Mo
Yoo Hyung-Jun
Seo Young-Seok
Kim Min-Suk
Lee Seung-Sook
Hwang Dae-Yong
Moon Sun-Mi
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Abstract
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Purpose: To evaluate the pathological prognostic factors related to local recurrence after radical surgery and
adjuvant radiation therapy in advanced rectal cancer.
Materials and Methods: Fifty-four patients with advanced rectal cancer who were treated with radical surgery
followed by adjuvant radiotherapy and chemotherapy between February 1993 and December 2001 were enrolled
in this study. Among these patients, 14 patients experienced local recurrence. Tissue specimens of the patients
were obtained to determine pathologic parameters such as histological grade, depth of invasion, venous
invasion, lymphatic invasion, neural invasion and immunohistopathological analysis for expression of p53, Ki-67,
c-erb, ezrin, c-met, phosphorylated S6 kinase, S100A4, and HIF-1 alpha. The correlation of these parameters
with the tumor response to radiotherapy was statistically analyzed using the chi-square test, multivariate
analysis, and the hierarchical clustering method.
Results: In univariate analysis, the histological tumor grade, venous invasion, invasion depth of the tumor and
the over expression of c-met and HIF-1 alpha were accompanied with radioresistance that was found to be
statistically significant. In multivariate analysis, venous invasion, invasion depth of tumor and over expression of
c-met were also accompanied with radioresistance that was found to be statistically significant. By analysis with
hierarchical clustering, the invasion depth of the tumor, and the over expression of c-met and HIF-1 alpha
were factors found to be related to local recurrence. Whereas 71.4% of patients with local recurrence had 2 or
more these factors, only 27.5% of patients without local recurrence had 2 or more of these factors.
Conclusion: In advanced rectal cancer patients treated by radical surgery and adjuvant chemo-radiation
therapy, the poor prognostic factors found to be related to local recurrence were HIF-1 alpha positive, c-met
positive, and an invasion depth more than 5.5 mm. A prospective study is necessary to confirm whether these
factors would be useful clinical parameters to measure and predict a radio-resistance group of patients.
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KEYWORD
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Rectal cancer, Local recurrence, Prognostic factor, Immunohistochemical analysis
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