Pathologic significance of tumor progression in locally recurrent rectal cancer: different nature from primary cancer.
OBJECTIVE
It has recently been demonstrated that the tumor growth rate is a stronger determinant of survival than the extent of the growth in local recurrence of rectal cancer. We studied which factors controlled the tumor growth rate using modern immunohistochemical methods.


METHODS
In 51 patients who underwent extended resection for this condition, paraffin-embedded specimens were examined for 1) tumor angiogenesis by CD31 staining and microvessel counting, 2) apoptosis by terminal deoxynucleotide transferase-mediated deoxyuridine triphosphate-biotin nick end-labeling staining, and 3) cellular proliferative activity using anti-proliferative cell nuclear antigen antibody. The results were compared with carcinoembryonic antigen doubling time and survival.


RESULTS
The five-year survival rate was 20 percent. The postoperative carcinoembryonic antigen doubling time, which was the strongest predictor of survival, correlated highly with proliferative cell nuclear antigen labeling index, but did not correlate with the apoptotic index or microvessel counts.


CONCLUSIONS
Our study shows that cancer cell proliferation rather than apoptosis or angiogenesis is a major determinant of tumor growth rate and survival in patients with locally recurrent rectal cancer.
Onodera
H
H
Department of Surgery and Surgical Basic Science, Faculty of Medicine, Kyoto University, Japan.
Maetani
S
S
Kawamoto
K
K
Kan
S
S
Kondo
S
S
Imamura
M
M
D000328:Adult; D000368:Aged; D017209:Apoptosis; D002272:Carcinoembryonic Antigen; D018450:Disease Progression; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009389:Neovascularization, Pathologic; D018809:Proliferating Cell Nuclear Antigen; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012044:Regression Analysis
D002272:Carcinoembryonic Antigen; D018809:Proliferating Cell Nuclear Antigen