Gender-related prognostic significance of clinical and biological tumor features in rectal cancer patients receiving short-course preoperative radiotherapy

Publication date: September–October 2017
Source:Reports of Practical Oncology & Radiotherapy, Volume 22, Issue 5
Author(s): Anna Gasinska, Zbigniew Darasz, Agnieszka Adamczyk, Beata Biesaga, Joanna Niemiec, Marian Reinfuss
AimTo study the prognostic value of clinical and biological features of rectal cancer and potential gender differences in patients' overall survival (OS), local recurrence-free survival (RFS) and metastasis-free survival (MFS) after short-course preoperative radiotherapy (SCRT) with short or long interval between RT and surgery (break).BackgroundThe length of the interval between RT and surgery in SCRT is debatable and gender-related differences in patients survival are not established yet.Materials and methods126 patients received SCRT with 5Gy dose per fraction during 5 days, followed by radical surgery after short break ≤17 days, and a long break >17 days. Pretreatment tumor proliferation (bromodeoxyuridine labeling index, BrdUrdLI and S-phase fraction) was evaluated by flow cytometry and proteins: CD34, Ki-67, GLUT-1, Ku70, BCL-2, P53 expression was studied immunohistochemically.ResultsThe studied group included 84 men and 42 women. There were 33, 76, and 17 cTNM (AJCC) tumor stages I, II, III, respectively. The median follow-up time was 53.3 months (range 2–142 months). For the whole group Cox multivariate analysis revealed that tumor grade (G>1), interval between RT and surgery >17 days, pTNM stage >1 and P53 positivity+BrdUrdLI>7.9% were negative prognostic factors for OS. Tumor aneuploidy and MVD>140.8vessels/mm² were important for RFS. pTNM stage>1 and P53 positivity combined with BrdUrdLI>7.9% were risk predictors for MFS. Based on tumor biological features, gender-related difference in OS, RFS, and MFS were observed. In multivariate analysis, male patients age>62 years and break >17 days only appeared to be significant for OS.ConclusionsIn male rectal patients treated with SCRT, breaks between RT and surgery >17 days should be avoided because they negatively influence patients' survival.



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