Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: The French randomised trial ACCORD12/0405 PRODIGE 2
Anne Rullier
(1)
,
Sophie Gourgou-Bourgade
(2)
,
Marta Jarlier
(2)
,
Frédéric Bibeau
(2)
,
Catherine Chassagne-Clement
(3)
,
Christophe Hennequin
(4)
,
Laurent Tisseau
(5)
,
Agnès Leroux
(6, 7)
,
Francette Ettore
(8)
,
Michel Peoc'H
(9)
,
Marie-Agnès Diebold
(10)
,
Yves-Marie Robin
(11)
,
Isabelle Kleinclaus
(12)
,
Laurent Mineur
(13)
,
Christophe Petitjean
(14)
,
Jean-François Mosnier
(15)
,
Isabelle Soubeyran
(16)
,
Norbert Padilla
(17)
,
Anne-Isabelle Lemaistre
(18)
,
Jocelyne Bérille
(19)
,
Bernard Denis
(12)
,
Thierry Conroy
(7, 6)
,
Jean-Pierre Gérard
(8)
1
CHU Bordeaux -
Centre Hospitalier Universitaire de Bordeaux
2 CRLCC Val d'Aurelle - Paul Lamarque
3 Centre Léon Bérard [Lyon]
4 Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)
5 Laboratoire de Pathologie [Saint Brieuc]
6 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
7 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
8 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
9 Laboratoire de Pathologie [Saint Priest en Jarez]
10 Hôpital Robert Debré
11 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
12 CH Colmar - Hôpital Louis Pasteur [Colmar]
13 Institut Sainte Catherine [Avignon]
14 Laboratoire medipath [Hyères]
15 Centre Hospitalier Universitaire de Nantes - Hôpital Hôtel-Dieu [Nantes]
16 Institut Bergonié [Bordeaux]
17 Laboratoire de Pathologie [Le Mans]
18 Laboratoire de Pathologie [Lyon]
19 UNICANCER [Paris]
2 CRLCC Val d'Aurelle - Paul Lamarque
3 Centre Léon Bérard [Lyon]
4 Fédération nationale des Centres de lutte contre le Cancer (FNCLCC)
5 Laboratoire de Pathologie [Saint Brieuc]
6 UNICANCER/ICL - Institut de Cancérologie de Lorraine - Alexis Vautrin [Nancy]
7 APEMAC - Maladies chroniques, santé perçue, et processus d'adaptation
8 UNICANCER/CAL - Centre de Lutte contre le Cancer Antoine Lacassagne [Nice]
9 Laboratoire de Pathologie [Saint Priest en Jarez]
10 Hôpital Robert Debré
11 UNICANCER/Lille - Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille]
12 CH Colmar - Hôpital Louis Pasteur [Colmar]
13 Institut Sainte Catherine [Avignon]
14 Laboratoire medipath [Hyères]
15 Centre Hospitalier Universitaire de Nantes - Hôpital Hôtel-Dieu [Nantes]
16 Institut Bergonié [Bordeaux]
17 Laboratoire de Pathologie [Le Mans]
18 Laboratoire de Pathologie [Lyon]
19 UNICANCER [Paris]
Marta Jarlier
- Fonction : Auteur
- PersonId : 768359
- ORCID : 0000-0002-5156-7395
Christophe Hennequin
- Fonction : Auteur
- PersonId : 835751
Michel Peoc'H
- Fonction : Auteur
- PersonId : 879489
- ORCID : 0000-0001-5453-0021
- IdRef : 069351678
Isabelle Soubeyran
- Fonction : Auteur
- PersonId : 762161
- ORCID : 0000-0001-7501-7622
Thierry Conroy
- Fonction : Auteur
- PersonId : 736936
- IdHAL : thierry-conroy
- ORCID : 0000-0001-7548-284X
- IdRef : 069112150
Jean-Pierre Gérard
- Fonction : Auteur
- PersonId : 1027336
Résumé
Circumferential resection margin (CRM) appears as a new powerful prognostic factor of survival after surgery for rectal cancer. We aimed to evaluate predictive factors of positive CRM following preoperative radiochemotherapy in a French trial. Patients with rectal cancer were randomised in long course preoperative radiotherapy 45 Gy plus capecitabine versus 50 Gy plus capecitabine and oxaliplatin. Mesorectal excision was performed 6 weeks after treatment. Impact of clinical, pathological and surgical variables on positive CRM (≤1 mm) were analysed by multivariate analysis. Of 565 randomised patients, CRM was recorded in 390 cases and was positive in 8% (30/390). Patients with 50 Gy plus capecitabine and oxaliplatin had a 6% rate of positive CRM while those treated by 45 Gy plus capecitabine had a 10% rate (p=0.128). Three independent predictive factors of positive CRM were identified: abdominoperineal resection (APR) (odds ratio OR=3.24; p=0.004), vascular tumour invasion (OR=2.78; p=0.026) and poor histological response (modified Dworak 0-2) (OR=9.01; p=0.003). Significant predictive factors of positive CRM are related to type of surgery, especially APR, and poor histological prognostic factors. Intensification of neoadjuvant radiochemotherapy does not seem to have a major role in this study.