Role of tumor size in the pre-operative management of rectal cancer patients

BMC Gastroenterology

Research Article

Frank Lehmann¹  Parham Minoo²  Efstratios S Patsouris³  George Peros⁴  Inti Zlobec⁵  Alessandro Lugli⁵  Eva Karamitopoulou⁶ 

[1] Department of Gastroenterology, University Hospital of Basel, Basel, Switzerland;Department of Pathology, University of California San Diego, San Diego, CA, USA;First Department of Pathology, University of Athens, Athens, Greece;Fourth Department of Surgery, University of Athens, Athens, Greece;Institute of Pathology, University Hospital of Basel, Basel, Switzerland;Second Department of Pathology, University of Athens, Athens, Greece;

关键词: Rectal Cancer;    Total Mesorectal Excision;    Tumor Diameter;    Rectal Cancer Patient;    Test Cohort;   

DOI  :  10.1186/1471-230X-10-61

 received in 2009-12-09, accepted in 2010-06-15,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundClinical management of rectal cancer patients relies on pre-operative staging. Studies however continue to report moderate degrees of over/understaging as well as inter-observer variability. The aim of this study was to determine the sensitivity, specificity and accuracy of tumor size for predicting T and N stages in pre-operatively untreated rectal cancers.MethodsWe examined a test cohort of 418 well-documented patients with pre-operatively untreated rectal cancer admitted to the University Hospital of Basel between 1987 and 1996. Classification and regression tree (CART) and logistic regression analysis were carried out to determine the ability of tumor size to discriminate between early (pT1-2) and late (pT3-4) T stages and between node-negative (pN0) and node-positive (pN1-2) patients. Results were validated by an external patient cohort (n = 28).ResultsA tumor diameter threshold of 34 mm was identified from the test cohort resulting in a sensitivity and specificity for late T stage of 76.3%, and 67.4%, respectively and an odds ratio (OR) of 6.67 (95%CI:3.4-12.9). At a threshold value of 29 mm, sensitivity and specificity for node-positive disease were 94% and 15.5%, respectively with an OR of 3.02 (95%CI:1.5-6.1). Applying these threshold values to the validation cohort, sensitivity and specificity for T stage were 73.7% and 77.8% and for N stage 50% and 75%, respectively.ConclusionsTumor size at a threshold value of 34 mm is a reproducible predictive factor for late T stage in rectal cancers. Tumor size may help to complement clinical staging and further optimize the pre-operative management of patients with rectal cancer.

【 授权许可】

CC BY   
© Zlobec et al; licensee BioMed Central Ltd. 2010