Valeur Pronostique de l’Écho-Endoscopie dans le Cancer du Rectum: Résultats d’une Analyse Multifactorielle

Radu Seicean1, Andrada Seicean2, Pascal Burtin3, Jean-Pierre Arnaud4, Marie-Christine Rousselet5, Patrice Cellier6, Philippe Dubois7, Jean Boyer3

1. Clinique Chirurgicale I. 2. Clinique Médicale III, Cluj-Napoca. 3. Service de Médecine A. 4. Service de Chirurgie Viscérale. 5. Service d’Anatomie Pathologique, Centre Hospitalier et Universitaire. 6. Centre Paul Papin, Angers, France

Abstract

Introduction. No study has evaluated the prognostic value of initial endorectal ultrasonography (ERUS) in rectal cancer (RC).

Aim. To assess the prognostic value of initial ERUS in operated patients with RC.

Material and methods. Eighty-four patients with non metastatic RC were examined by ERUS before treatment. Forty-two received preoperative radiation therapy and they were resected 7 weeks later on average. The prognostic value of uTN and pTN classification was analysed by means of a Cox model, taking into account the realization of preoperative radiation therapy.

Results. In the univariate analysis, 4 variables were predictive of prognosis: elevation of alkaline phosphatases, the degree of circonference, the extension of the resection margin, and the involvement of perirectal lymph nodes. The multivariate analysis showed that when considering only pTN and uTN classifications, only uT and pN kept a significant prognostic value. The better prognostic role of uT was due to a close relationship with preoperative radiation therapy which was responsible for a significant downstaging.

Conclusion. Since preoperative radiotherapy has become a standard in France, the prognostic value of ERUS has emerged, better than pTN classification when radiotherapy has been preoperatively applied. Other prognostic factors should be investigated in a more homogeneous population of patients, all presurgically irradiated.

Key words

Rectal cancer - staging - endorectal ultrasonography