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1Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea
2Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
© 2019 The Korean Society of Coloproctology
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
Values are presented as mean ± standard deviation or number (%).
CRT, chemoradiotherapy; CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; OR, odds ratio; CI, confidence interval; LAR, low anterior resection; ISR, intersphincteric resection; APR, abdominoperineal resection; mrTRG, magnetic resonance imaging tumor regression grade.
CRM, circumferential resection margin; CRT, chemoradiotherapy; CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; HR, hazard ratio; CI, confidence interval; mrTRG, magnetic resonance imaging tumor regression grade; LAR, low anterior resection; ISR, intersphincteric resection; APR, abdominoperineal resection; WD, well differentiated; MD, moderately differentiated; PD, poorly differentiated; TRG, tumor regression grade.
Variable | Univariate analysis |
P-value | Multivariate analysis |
P-value | ||
---|---|---|---|---|---|---|
Persistent CRM (n = 72) | Converted CRM (n = 40) | OR | 95% CI | |||
Age (yr) | 64.0 ± 11.0 | 65.0 ± 10.5 | 0.617 | |||
Sex | 1.000 | |||||
Male | 51 (70.8) | 29 (72.5) | ||||
Female | 21 (29.2) | 11 (27.5) | ||||
Body mass index (kg/m²) | 22.6 ± 3.1 | 22.9 ± 2.6 | 0.602 | |||
Hemoglobin (g/dL) | 12.7 ± 2.3 | 12.7 ± 2.4 | 0.925 | |||
Tumor location | 0.055 | 0.007 | ||||
Low | 17 (23.6) | 18 (45.0) | 1.000 | - | ||
Mid/upper | 55 (76.4) | 22 (55.0) | 3.927 | 1.492–11.182 | ||
Tumor size (cm) | 0.977 | |||||
≤5 | 29 (40.3) | 17 (42.5) | ||||
>5 | 43 (59.7) | 23 (57.5) | ||||
CEA at diagnosis (ng/mL) | 0.122 | |||||
≤5 | 26 (36.1) | 21 (52.5) | ||||
>5 | 46 (63.9) | 19 (47.5) | ||||
mrT category | 0.020 | 0.268 | ||||
2/3 | 47 (65.3) | 35 (87.5) | 1.000 | - | ||
4 | 25 (34.7) | 5 (12.5) | 1.936 | 0.628–6.771 | ||
mrN category | 0.458 | |||||
0 | 6 (8.3) | 7 (17.5) | ||||
1 | 21 (29.2) | 10 (25.0) | ||||
2 | 45 (62.5) | 23 (57.5) | ||||
mrEMVI | <0.001 | 0.030 | ||||
No | 8 (11.1) | 16 (40.0) | 1.000 | - | ||
Yes | 64 (88.9) | 24 (60.0) | 3.319 | 1.146–10.149 | ||
Differentiation | 0.421 | |||||
Well | 38 (52.8) | 25 (62.5) | ||||
Moderately | 31 (43.1) | 15 (37.5) | ||||
Poorly | 3 (4.2) | 0 (0) | ||||
Pathologic CRM | 0.436 | |||||
Involved | 26 (36.1) | 2 (5.0) | ||||
Not involved | 46 (63.9) | 38 (95.0) |
Variable | Univariate analysis |
P-value | Multivariate analysis |
P-value | ||
---|---|---|---|---|---|---|
Pathologic CRM not involved (n = 84) | Pathologic CRM involved (n = 28) | OR | 95% CI | |||
Age (yr) | 65.1 ± 10.6 | 62.1 ± 11.2 | 0.222 | |||
Sex | 1.000 | |||||
Male | 60 (71.4) | 20 (71.4) | ||||
Female | 24 (28.6) | 8 (28.6) | ||||
Body mass index (kg/m²) | 22.8 ± 2.8 | 22.4 ± 3.2 | 0.536 | |||
Hemoglobin (g/dL) | 12.9 ± 2.2 | 12.7 ± 2.5 | 0.127 | |||
Tumor location | 0.178 | |||||
Low | 24 (28.6) | 11 (39.3) | ||||
Mid/upper | 60 (71.4) | 17 (60.7) | ||||
Tumor size at after CRT (cm) | 0.512 | |||||
≤5 | 47 (56.0) | 13 (46.4) | ||||
>5 | 37 (44.0) | 15 (53.6) | ||||
CEA after CRT (ng/mL) | 0.038 | 0.134 | ||||
≤5 | 24 (28.6) | 2 (7.1) | 1.000 | - | ||
>5 | 60 (71.4) | 26 (92.9) | 3.557 | 0.795–25.669 | ||
ymrT category | 0.005 | 0.164 | ||||
0–2 | 77 (91.7) | 19 (67.9) | 1.000 | - | ||
3–4 | 7 (8.3) | 9 (32.1) | 2.859 | 0.662–13.314 | ||
ymrN category | 0.021 | 0.469 | ||||
Negative | 44 (52.4) | 7 (25.0) | 1.000 | - | ||
positive | 40 (47.6) | 21 (75.0) | 1.539 | 0.480–5.097 | ||
ymr EMVI | 0.002 | 0.524 | ||||
No | 56 (66.7) | 9 (32.1) | 1.000 | - | ||
Yes | 28 (33.3) | 19 (67.9) | 1.501 | 0.429–5.373 | ||
Differentiation | 0.381 | |||||
Well | 50 (59.5) | 13 (46.4) | ||||
Moderately | 32 (38.1) | 14 (50.0) | ||||
Poorly | 2 (2.4) | 1 (3.6) | ||||
ymr CRM | <0.001 | 0.025 | ||||
Converted | 38 (45.2) | 2 (7.1) | 1.000 | - | ||
Not converted | 46 (54.8) | 26 (92.9) | 7.030 | 1.497–52.515 | ||
Surgery type | 0.018 | |||||
LAR | 46 (54.8) | 7 (25.0) | 1.000 | - | ||
ISR | 30 (35.7) | 15 (53.6) | 5.748 | 1.765–21.801 | 0.006 | |
APR | 7 (8.3) | 6 (21.4) | 6.164 | 1.219–35.071 | 0.031 | |
mrTRG | 0.036 | |||||
0–2 | 20 (23.8) | 2 (7.1) | 1.000 | - | 0.711 | |
3/4 | 64 (76.2) | 26 (92.9) | 1.557 | 0.190–33.111 |
Variable | LRFS |
DFS |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Before CRT | ||||
Age (yr) | ||||
≤65 vs. >65 | 1.008 (0.453–2.246) | 0.983 | 1.071 (0.628–1.827) | 0.799 |
Sex | ||||
Male vs. female | 1.862 (0.635–5.455) | 0.226 | 1.263 (0.709–2.246) | 0.433 |
Body mass index (kg/m²) | ||||
≤25 vs. >25 | 4.770 (0.644–35.355) | 0.090 | 1.176 (0.574–2.408) | 0.651 |
Tumor location | ||||
Low vs. mid/upper | 2.595 (1.159–5.806) | 0.023 | 1.379 (0.787–2.418) | 0.269 |
Tumor size (cm) | ||||
>5 vs. ≤5 | 2.361 (1.056–5.277) | 0.039 | 1.554 (0.893–2.704) | 0.126 |
CEA at diagnosis (ng/mL) | ||||
>5 vs. ≤5 | 1.831 (0.819–4.089) | 0.140 | 1.499 (0.878–2.558) | 0.139 |
mrT category | ||||
4 vs. 2/3 | 3.620 (1.585–8.253) | 0.003 | 2.207 (–1.238–3.933) | 0.010 |
mrN category | ||||
N+ vs. N0 | 3.584 (0.484–26.543) | 0.125 | 2.595 (0.809–8.318) | 0.063 |
mrEMVI | ||||
Yes vs. no | 9.003 (1.211–66.901 | 0.002 | 7.026 (2.184–22.593) | 0.001 |
Differentiation | ||||
WD vs. MD/PD | 1.228 (0.550–2.743) | 0.617 | 1.481 (0.867–2.525) | 0.151 |
After CRT | ||||
Tumor size at after CRT (cm) | ||||
>5 vs. ≤5 | 3.952 (1.727–9.047) | <0.001 | 1.554 (0.893–2.704) | 0.126 |
CEA after CRT (ng/mL) | ||||
>5 vs. ≤5 | 2.749 (1.173–6.446) | 0.027 | 2.359 (1.065–5.223) | 0.019 |
ymrT category | ||||
4 vs. 2/3 | 5.323 (2.270–12.483) | <0.001 | 2.576 (1.339–4.958) | 0.009 |
ymrN category | ||||
N+ vs. N0 | 2.603 (1.078–6.284) | 0.025 | 1.510 (0.880–2.590) | 0.140 |
ymrEMVI | ||||
Yes vs. No | 3.456 (1.476–8.091) | 0.003 | 2.665 (1.543–4.603) | <0.001 |
ymrCRM | ||||
Not converted vs. converted | 3.471 (1.184–10.170) | 0.010 | 2.537 (1.332–4.833) | 0.002 |
mrTRG | ||||
0–2 vs. 3/4 | 6.321 (1.010–46.757) | 0.015 | 2.720 (1.083–6.831) | 0.014 |
Pathologic variable | ||||
Surgery type | ||||
SSS vs. SPS | 2.716 (1.071–6.884) | 0.054 | 1.538 (0.723–3.271) | 0.287 |
Lymphovascular invasion | ||||
Yes vs. no | 2.397 (0.949–6.056) | 0.088 | 1.435 (0.700–2.941) | 0.343 |
Perineural invasion | ||||
Yes vs. no | 3.032 (1.345–6.835) | 0.007 | 1.510 (0.880–2.590) | 0.140 |
Pathologic CRM | ||||
Involved vs. not involved | 10.325 (4.258–25.033) | <0.001 | 3.472 (2.020–5.965) | <0.001 |
Pathologic T | ||||
3/4 vs. 0–2 | 2.864 (0.672–12.210) | 0.100 | 3.437 (1.239–9.534) | 0.004 |
Pathologic N | ||||
Yes vs. No | 2.608 (1.114–6.103) | 0.022 | 2.175 (1.225–4.844) | 0.015 |
Distal margin (cm) | ||||
<1 vs. ≥1 | 0.864 (0.257–2.902) | 0.810 | 1.037 (0.467–2.301) | 0.928 |
Pathologic TRG | ||||
0–2 vs. 3/4 | 1.516 (0.676–3.399) | 0.314 | 1.001 (0.577–1.735) | 0.998 |
Variable | LRFS |
DFS |
||
---|---|---|---|---|
HR (95% CI) | P-value | HR (95% CI) | P-value | |
Before CRT | ||||
Tumor location | ||||
Low vs. mid/upper | 3.205 (1.251–8.209) | 0.015 | ||
Tumor size (cm) | ||||
>5 vs. ≤5 | 4.224 (1.771–10.078) | 0.001 | ||
mrT category | ||||
4 vs. 2/3 | 4.762 (1.843–12.302) | 0.001 | ||
mrEMVI | ||||
Yes vs. no | 6.007 (1.846–19.546) | <0.001 | ||
After CRT | ||||
ymrT category | ||||
LAR vs. ISR | 4.303 (5.010–59.211) | 0.012 | ||
LAR vs. APR | 17.223 (1.782–10.019) | <0.001 | ||
ymrCRM | ||||
Not converted vs. converted | 4.380 (1.469–13.058) | 0.008 | 1.832 (1.020–3.702) | 0.048 |
ymrEMVI | ||||
Yes vs. no | – | 2.111 (1.164–3.826) | 0.014 | |
Pathologic variables | ||||
Pathologic N | ||||
Yes vs. no | 2.292 (1.290–4.067) | 0.004 | ||
Pathologic CRM | ||||
Involved vs. not involved | 9.580 (3.458–26.535) | <0.001 | 2.349 (1.352–4.068) | 0.002 |
Values are presented as mean ± standard deviation or number (%). CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; OR, odds ratio; CI, confidence interval.
Values are presented as mean ± standard deviation or number (%). CRT, chemoradiotherapy; CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; OR, odds ratio; CI, confidence interval; LAR, low anterior resection; ISR, intersphincteric resection; APR, abdominoperineal resection; mrTRG, magnetic resonance imaging tumor regression grade.
CRM, circumferential resection margin; CRT, chemoradiotherapy; CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; HR, hazard ratio; CI, confidence interval; mrTRG, magnetic resonance imaging tumor regression grade; LAR, low anterior resection; ISR, intersphincteric resection; APR, abdominoperineal resection; WD, well differentiated; MD, moderately differentiated; PD, poorly differentiated; TRG, tumor regression grade.
CRT, chemoradiotherapy; CEA, carcinoembryonic antigen; EMVI, extramural venous invasion; HR, hazard ratio; CI, confidence interval; mrTRG, magnetic resonance imaging tumor regression grade; LAR, low anterior resection; ISR, intersphincteric resection; APR, abdominoperineal resection.