Heather Jones, MD
University of Pennsylvania Cancer Center
Last Modified: November 4, 2001
Presenter: L.L. Gunderson
Affiliation: Institution: Oncology, Mayo Clinic, Rochester, MN
This study attempts to evaluate the TMN staging and the MAC staging as predictors of outcome such as overall survival and patterns of failure for patients with rectal cancer who have undergone adjuvant therapy. The study evaluates patients from 3 randomized studies in North America.
Patients with only a single high-risk factor of either extension beyond the rectal wall or nodal involvement have improved OS, DFS and disease control when compared to those with both high risk factors. For the purposes of future trial design, it may be appropriate to perform separate studies for the "intermediate risk" subsets of T3N0 and T1-2N1 vs the "moderately high" or "high risk" subsets in view of differential survival and rates of relapse.
This is a very interesting study that would seem to indicate that the TMN and MAC are not clear prognostic indicators of functional outcome as previously believed. Even more interesting is the independent prognostic factor of T stage in the Nodal groups. This study clearly demonstrates that there is a selective group of N2 patients with disease confined to the rectal wall that has better overall survival and disease- free survival than traditionally would be predicted.