Rectal Cancer
Conditions
Keywords
Early rectal cancer, Ploidy, Tumour:stroma ratio
Brief summary
Early rectal cancer can be removed by minimally-invasive surgery, and the standard pathological assessment of the removed tumour gives valuable information about how advanced the tumour is. This gives an indication of how likely the cancer is to recur, so doctors and patient can decide on the most appropriate further treatment and follow-up. However there is still much uncertainty in these predictions about recurrence. This study will assess two further pathology tests, ploidy and stroma ratio in the tumour, by correlating the results with outcome. This will determine whether these two tests provide additional value in predicting outcome. If so, clinicians would be better able to advise patients with early rectal cancer about their prognosis and further management.
Detailed description
Early rectal cancer can be removed by minimally-invasive surgery, and the standard pathological assessment of the removed tumour gives valuable information about how advanced the tumour is. This information is very important in indicating whether the cancer is likely to recur, and therefore in advising the patient after surgery whether further treatment is advisable, and if not, what is the most appropriate follow-up regime. However there is still a lot of uncertainty in these predictions about recurrence of the cancer, and better tests are being sought. This study aims to look at two further pathology tests, ploidy and stroma ratio in the tumour, and correlate these test results with outcome in patients who have had an early rectal cancer removed. This will allow the investigators to assess whether these two tests provide additional value in predicting outcome. If so, clinicians would be better able to advise patients with early rectal cancer about their prognosis and further management. Routine histopathology analysis of a rectal cancer specimen removed at surgery includes assessment of tumour size, depth of invasion, vascular, lymphatic and perineural invasion, tumour involvement of resection margins and nodal involvement. This information is valuable in predicting outcome. For example, predicted rates of local recurrence at 36 months following local excision of rectal cancer by transanal endoscopic microsurgery (TEM) based on tumour size, depth of invasion and lymphatic invasion have been tabulated. However such models are not perfect, and leave room for improvement. Ploidy and stroma ratio are two further tests which have shown some promise in predicting outcome. Ploidy refers to the number of sets of chromosomes in a cell nucleus. Most human cells are normally diploid, with two sets of 23 chromosomes. Abnormal tumour cells may have a different number of sets of chromosomes, or be aneuploid, having some replicated or deleted chromosomes. In general, aneuploidy in cancer cells is associated with a worse prognosis. An early study of DNA ploidy in rectal cancer using flow cytometry showed an independent but small predictive effective of aneuploidy on survival. Technological advances now allow more accurate and detailed assessment of ploidy. The DNA ploidy status of tumour cells in early ovarian cancer has been found to predict which patients will benefit from adjuvant chemotherapy after surgery to remove the ovarian tumour and is used routinely in some centres to aid in decision-making. Stroma ratio refers to the tumour: stroma ratio. A lower proportion of tumour cells or, conversely, a higher percentage of stroma, in a cancer tends to be associated with a poorer prognosis. This ratio has been found to be strongly associated with tumour growth and invasion in colorectal cancers, and to independently predict survival in patients undergoing surgery to removal colorectal tumours. However previous studies have looked mainly at more advanced colon cancers, rather than early rectal cancers, and have used only cancer-related death as the endpoint, rather than looking at local recurrence and response to adjuvant treatments.
Interventions
OTHERPloidy and tumour:stromal ratio measurements
Ploidy and tumour:stromal ratio measurements will be made on specimens of early rectal cancer removed by transanal endoscopic microsurgery (TEM)
Sponsors
Oslo University Hospital
Oxford University Hospitals NHS Trust
Study design
Observational model
COHORT
Time perspective
OTHER
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participant is willing and able to give informed consent (in English) for participation in the study, or gave informed consent for donation of tissue for research at the time of surgery * Male or Female, aged 18 years or above * Diagnosed with operable rectal cancer * Due to undergo, or has already undergone, TEM surgery to remove rectal cancer * A useable tissue sample has already been, or will be, taken as part of routine surgery
Exclusion criteria
* Age less than 18 * Adults who are not able to give consent or who are deemed vulnerable * Participants who do not have a useable tissue sample will be excluded
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Ploidy Status With Local Recurrence of Cancer | a minimum of 6 months after surgery | Results of ploidy status will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation with local recurrence of the rectal cancer |
| Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer | a minimum of 6 months after surgery | Results of tumour:stromal ratio (TSR) will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation with local recurrence of the rectal cancer. A 50% cut-off is used to define high TSR. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer | a minimum of 6 months after surgery | Results of ploidy status will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation between the test results and overall survival |
| Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer | a minimum of 6 months after surgery | Results of tumour:stromal ratio (TSR) will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation between the test results and overall survival. High TSR is defined using a 50% cut-off. |
Countries
United Kingdom
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Patients All patients | 143 |
| Total | 143 |
Baseline characteristics
| Characteristic | Patients | — |
|---|---|---|
| Age, Continuous | 69 years | — |
| Post-TEM management Adjuvant radiotherapy | 42 Participants | — |
| Post-TEM management Completion radical surgery | 13 Participants | — |
| Post-TEM management Surveillance | 88 Participants | — |
| Race and Ethnicity Not Collected | — | — Participants |
| Region of Enrollment United Kingdom | 143 participants | — |
| Sex: Female, Male Female | 56 Participants | — |
| Sex: Female, Male Male | 87 Participants | — |
| Tumour stage pT1 (tumour confined to the inner layer of the bowel) | 76 Participants | — |
| Tumour stage pT2 (tumour extends into the muscle layer of the bowel wall) | 58 Participants | — |
| Tumour stage pT3 (tumour has reached the outer lining of the bowel wall) | 9 Participants | — |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 27 / 143 |
| other Total, other adverse events | 0 / 143 |
| serious Total, serious adverse events | 0 / 143 |
Outcome results
Primary
Correlation Between Ploidy Status With Local Recurrence of Cancer
Results of ploidy status will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation with local recurrence of the rectal cancer
Time frame: a minimum of 6 months after surgery
Population: Only patients for whom ploidy status was available were included in the analysis (ploidy assessment failed in 3 patients for technical reasons)
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Patients | Correlation Between Ploidy Status With Local Recurrence of Cancer | Diploid - Local recurrence | 3 Participants |
| Patients | Correlation Between Ploidy Status With Local Recurrence of Cancer | Diploid - No local recurrence | 31 Participants |
| Patients | Correlation Between Ploidy Status With Local Recurrence of Cancer | Non-diploid - Local recurrence | 14 Participants |
| Patients | Correlation Between Ploidy Status With Local Recurrence of Cancer | Non-diploid - No local recurrence | 92 Participants |
Primary
Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer
Results of tumour:stromal ratio (TSR) will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation with local recurrence of the rectal cancer. A 50% cut-off is used to define high TSR.
Time frame: a minimum of 6 months after surgery
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Patients | Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer | High TSR - Local recurrence | 2 Participants |
| Patients | Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer | High TSR - No local recurrence | 9 Participants |
| Patients | Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer | Low TSR - Local recurrence | 17 Participants |
| Patients | Correlation Between Tumour: Stroma Ratio With Local Recurrence of Cancer | Low TSR - No local recurrence | 115 Participants |
Secondary
Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer
Results of ploidy status will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation between the test results and overall survival
Time frame: a minimum of 6 months after surgery
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Patients | Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer | Diploid - Alive | 27 Participants |
| Patients | Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer | Diploid - Deceased | 7 Participants |
| Patients | Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer | Non-diploid - Alive | 86 Participants |
| Patients | Correlation Between Ploidy Status and Overall Survival After TEM Surgery to Remove Rectal Cancer | Non-diploid - Deceased | 20 Participants |
Secondary
Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer
Results of tumour:stromal ratio (TSR) will be correlated with patient follow-up information for between 6 months and 9 years following surgery, to look for any correlation between the test results and overall survival. High TSR is defined using a 50% cut-off.
Time frame: a minimum of 6 months after surgery
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Patients | Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer | High TSR - Alive | 6 Participants |
| Patients | Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer | High TSR - Deceased | 5 Participants |
| Patients | Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer | Low TSR - Alive | 110 Participants |
| Patients | Correlation Between Tumour:Stroma Ratio and Overall Survival After TEM Surgery to Remove Rectal Cancer | Low TSR - Deceased | 22 Participants |