title: Towards a "Lyon molecular signature" to individualize the treatment of rectal cancer. Prognostic analysis of a prospective cohort of 94 rectal cancers T1-2-3 Nx MO to be the basis of a molecular signature.
abstract: OBJECTIVE
  In 1998 a translational research was initiated in Lyon aiming at identifying a prognostic "biomolecular signature" in rectal cancer. This paper presents the clinical outcome of the patients included in this study.
  
  
  METHODS
  A total of 94 patients were included between 1998 and 2001. A staging with rectoscopy and biopsies was performed before treatment. In case of surgery, the operative specimen was analysed to evaluate the pathological response. There were two types of treatment: neoadjuvant radiotherapy (with or without concurrent chemotherapy) followed by surgery (76 cases) and radiotherapy alone with 'contactherapy' often associated with external beam radiotherapy (18 patients).
  
  
  RESULTS
  The patients had a mean age of 63years. Stage was T1: 4, T2: 24, T3: 65 and T4: 1. The overall survival of the 94 patients was 62% at 8years with a rate of distant metastases of 29%. Rate of local recurrence at 8years was 6% in the neoadjuvant group and 16% in the radiotherapy group with an overall 8years survival in both groups respectively: 64% and 53%. There was a trend towards more metastases in cT3, tumour diameter above 4cm, circumferential extension. There was a significant increase in the risk of metastases for ypT3, ypN1-2 and Dworak score 1-2-3. In multivariate analysis ypT3 was significantly associated with a high rate of metastases (55%; P=0.0003).
  
  
  CONCLUSIONS
  The rate of distant metastases is a major prognostic factor. These clinical results will serve as the base line to identify a "biomolecular signature" which could complement the TN(M) classification.
authors.affiliation: Radiotherapy Department, Cyclotron Biomédical, Centre Antoine-Lacassagne, 277, avenue de la Lanterne, 06200 Nice, France. jean-pierre.gerard@nice.unicancer.fr
authors.forename: J-P
authors.initials: JP
authors.lastname: Gérard
authors.forename: J
authors.initials: J
authors.lastname: Baulieux
authors.forename: J
authors.initials: J
authors.lastname: Doyen
authors.forename: J
authors.initials: J
authors.lastname: Gal
authors.forename: E
authors.initials: E
authors.lastname: Letouze
authors.forename: S
authors.initials: S
authors.lastname: Olschwang
authors.forename: O
authors.initials: O
authors.lastname: Chapet
authors.forename: P
authors.initials: P
authors.lastname: Romestaing
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D018570:Risk Assessment