title: Adjuvant therapy for T3N0 rectal cancer in the total mesorectal excision era- identification of the high risk patients.
abstract: BACKGROUND
  Adjuvant therapy for T3N0 rectal cancer was controversial with respect to both radiation and the use of a combined regimen of chemotherapy. We evaluated both clinical features and biomarkers and sought to determine risk factors for those patients retrospectively.
  
  
  METHODS
  A total of 122 patients with T3N0 rectal cancer were analyzed in this study from January 2000 to December 2005. Clinicopathologic and biomarkers were used to predict local recurrence (LR), disease-free survival (DFS), and overall survival (OS).
  
  
  RESULTS
  The median follow-up interval was 45.4 months. Five-year LR, DFS, and OS rates were 10.4%, 68.3%, and 88.7%. Having a lower tumor location and showing low P21 and high CD44v6 expression were identified as risk factors for LR: patients with two or three of these risk factors had a higher 5-year LR rate (19.3%) than did patients with none or one of these risk factors (6.8%) (p = 0.05). A poorer DFS was related to low P21 nor high CD44v6 expression but not to tumor location: the 5-year DFS rates were 79.3% for those with neither, 65.9% for those with either one or the other, and 16.9% for those with both (p = 0.00).
  
  
  CONCLUSIONS
  The prognostic model including tumor location, P21 and CD44v6 expressions could help to distinguish these patients with high risk T3N0 patients and determine whether adjuvant therapy was beneficial.
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, PR China.
authors.forename: Ji
authors.initials: J
authors.lastname: Zhu
authors.forename: Ye
authors.initials: Y
authors.lastname: Xu
authors.forename: Weilie
authors.initials: W
authors.lastname: Gu
authors.forename: Junjie
authors.initials: J
authors.lastname: Peng
authors.forename: Gang
authors.initials: G
authors.lastname: Cai
authors.forename: Guoxiang
authors.initials: G
authors.lastname: Cai
authors.forename: Wenjie
authors.initials: W
authors.lastname: Sun
authors.forename: Weiqi
authors.initials: W
authors.lastname: Shen
authors.forename: Sanjun
authors.initials: S
authors.lastname: Cai
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors