INFLUENCE OF TUMOUR DIFFERENTIATION ON SURVIVAL AFTER RESECTION FOR RECTAL CANCER IN A SERIES OF 1296 PATIENTS

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Abstract
The influence of differentiation grade on tumor staging, local recurrence and long term survival propects was evaluated in a series of patients managed by resection for rectal cancer. Differentiation was known in 1095 of 1296 patients. Well-differentiated tumors were over-represented among Dukes'' stage A cases and poorly differentiated among those with disseminated disease (P < 0.001). Local recurrence was twice as common (31%) after curative resection of poorly differentiated tumors than of well (14%) or moderately (17%) differentiated. Cancer specific survival rates [5 yr] after resection (curative and palliative combined) of tumors of good, average or poor differentiation were 68%, 59% and 33%, respectively. After potentially curative resection, survival was also significantly worse in patients with poorly differentiated tumors (P < 0.001); 5 yr survival rates of patients with tumors of good, average or poor differentiation were 75%, 71% and 51%, respectively. Survival prospects beyond 5 yr in patients with Dukes'' stage A tumors were significantly reduced when the tumor was poorly differentiated; 5 and 10 yr survival rates were 76% and 40%, respectively. Patients with Dukes'' stage C tumors of poor differentiation had an identical 5 and 10 yr cancer specific survival, 26%. Patients with mucoid type tumors had worse survival prospects than those with non-mucoid type (P < 0.02).