Proliferating cell nuclear antigen as a prognostic factor after total mesorectal excision of stage II-III rectal cancer.
BACKGROUND
Proliferating cell nuclear antigen (PCNA) is an auxiliary protein of DNA polymerase delta that is tightly associated with sites of DNA replication; whether PCNA is a definite prognostic factor remains controversial. This study determined the clinicopathological factors associated with the long-term oncological outcome after radical resection of stage II-III rectal cancer, focusing on PCNA.


METHODS
We retrospectively reviewed 135 consecutive patients who underwent curative surgery for stage II-III rectal cancer between August 2001 and April 2004. Prognostic factors including immunohistochemical PCNA expression and the clinical outcome were evaluated.


RESULTS
The PCNA index correlated with lymph node metastasis (P = 0.010). A multivariate analysis identified two independent factors that significantly affected both disease-free and overall survival: lymph node metastasis and PCNA index. With a median follow-up period of 60 months (range 8-87 months), both 5-year disease-free and overall survival of the low PCNA group were significantly higher than those of the high PCNA group (71.8% versus 32.0%, P < 0.001; 83.9% versus 50.0%, P < 0.001, respectively).


CONCLUSIONS
For patients undergoing curative resection for rectal cancer, pathological N stage and high PCNA expression can provide valuable prognostic information about survival. This study suggests that the PCNA index may be used as an independent prognostic factor in stage II-III rectal cancer patients.
Huh
Jung Wook
JW
Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Jeonnam, Korea.
Kim
Hyeong Rok
HR
Kim
Young Jin
YJ
D000230:Adenocarcinoma / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000096:biosynthesis*; D012004:Rectal Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D018809:Proliferating Cell Nuclear Antigen