Prognosis and quality of life in patients with locally advanced rectal cancer after abdominoperineal resection in the CAO/ARO/AIO-04 randomized phase 3 trial

Low anterior resection (LAR) and abdominoperineal resection (APR) are the two main surgical procedures after preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. APR is associated with poorer prognosis; however existing data do not consider intensified CRT (5-Fluorouracil (5-FU)/Oxaliplatin + radiation) protocols. Clinicopathological data of patients treated with APR and LAR from the CAO/ARO/AIO-04 trial were analysed in terms of prognostic parameters and quality of life (QoL). Based on higher response rate after intensified CRT, subgroup analyses were performed. Data from n = 1173 patients were assessed. APR after preoperative CRT was associated with a significantly worse overall survival (p = 0.0056), disease-free survival (p < 0.0001) and local recurrence rate (p = 0.0047). Clinicopathological data including clinical T stage (p < 0.000001), grading (p = 0.0038), postoperative lymph node (LN) positivity (p = 0.013), and number of positive LN (p = 0.0049) significantly differed between procedures and showed higher values in APR patients. The quality of total mesorectal excision (TME) was significantly better (p < 0.0001) and complete resection rates were higher (p = 0.0022) in LAR compared to APR patients. Subgroup analyses showed worse LR rates in APR patients after standard CRT (5-FU mono and radiation) but not after intensified CRT. After 3 years, role functioning (p = 0.019) and physical functioning (p = 0.001) had a slightly poorer outcome in APR patients. The poorer prognosis of patients undergoing APR for locally advanced rectal cancer may be explained by clinicopathological characteristics. Intensified CRT may compensate for the higher risk of LR after APR in patients with worse TME quality. QoL in APR patients was comparable to LAR patients.

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Scientific Reports
Published
2025-02-13
DOI
https://doi.org/10.1038/s41598-024-83105-z
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3
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Colorectal Cancer Surgical Treatments
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article

Prognosis and quality of life in patients with locally advanced rectal cancer after abdominoperineal resection in the CAO/ARO/AIO-04 randomized phase 3 trial

Richard Ringel, Scott Walter, Tobias Großner, Sheilah Dols et al.
3 citations
Scientific Reports
Colorectal Cancer Surgical Treatments
3.14
article

Prognosis and quality of life in patients with locally advanced rectal cancer after abdominoperineal resection in the CAO/ARO/AIO-04 randomized phase 3 trial

Richard Ringel, Scott Walter, Tobias Großner, Sheilah Dols, Johannes Fischinger, Christoph Becker, J. Stöhlmacher, T. Berns, Daniel Zips, A Bremer, Godehard Lahmer, W Scheppach, Joerg Seraphin, Arnulf Dörner, Malcolm Kohler, O. Dworák, Martin Lainka, G. Spira, Anke Mütherig, Anke Schlenska‐Lange, Guido T. Bommer, Michael B. Ghadimi, M. M. Heiss, Markus A. Bendel, G. Zuz, Thomas Meyer, B. Stinner, H. Arps, Ulrike Soeling, M. Niewiera, Th. Auberger, Dorothee Watz, Hartwig Kosmehl, H. Leber, Robert Grützmann, W. Bischof, Andreas Wirsching, Volker Groß, A. Röhrborn, Gerald Illerhaus, Dominik Wulf, U. Gönner, Thomas Wiegel, Felix Momm, A. Hartmann, B. Högel, Rebekka Kosmala, Stefan De Wachter, M. Zitzelsberger, Robert Gosenheimer, Claus Rödel, Gabriele Beckmann, N. Gulzad, D. B. HORN, A. Scherpe, Oliver Kölbl, Oliver Schneider, Miriam Rottmann, V. Bendel, I. Wagner, Michael Kranzfelder, R. Keymer, Günther Klautke, Tim Beißbarth, M. Raub, Karolin Trautmann‐Grill, Dirk Strumberg, E. Roemer, B. J. Leibl, Andrea Speidel, S. Staar, Marcus Niewald, Lutz Dietze, Uwe Will, Pompiliu Piso, Thomas Wendt, Hildegard Holzinger, Gunnar Folprecht, Ralf Oppenkowski, H.-J. Gassel, Ulrich Grabenhorst, G Schmidt, H. Becker, Azadeh Azizian, Regine Breitsprecher, Claus Michael Rödel, Irenäus A. Adamietz, S. Bartelt, Ute Küchenmeister, Arlo Radtke, Kerstin Ziegler, Bruno Weber, R. Hesterberg, Thomas Kubin, Diego Greif, Christian Hagel, Chan Kwon Jung, W. Schlosser, Johannes Lutterbach, Jochen Gaedcke, Johann Michael Kraus, Beate Krammer‐Steiner, Heidi Wagner, Hans-Peter Rösler, W. Matek, A. Bittrich, I. A. Adamietz, M. Hoffmann, Karsten Schulmann, Ludger Staib, Diana Ackermann, Sara Grehl, Claus-Christoph Steffens, C. Rudat, Hans Geinitz, Peter Herzog, Matthias Kühn, J. Fischbein, Torsten Liersch, Amanda Beyer, Joel M. Kreitzer, C Beck, Cornelia Schäffer, Emmanouil Fokas, Holger Hebart, Werner Kneist, Sven Detken, Matthias Patz, Florian Weißinger, H. H. Dahm, Volker Heinemann, Andreas Küsters, A. Altendorf-Hofmann, Josef Rüschoff, Heinrich Wiesinger, R. Rosenberg, Katharina Barkhausen, N. Steigemann, Jürgen Heide, Karl Verpoort, Ricardo P.J. Budde, Felix Rühlmann, C. Gabor, Heinz Dürk, K.-D. Rüdiger, Detlef Imhoff, Ganna Rudykina, Anke Reinacher‐Schick, H. Gnann, T Strauß, T Lehnert, Wolfgang Hiddemann, B. Dreuw, Susanne Simon-Becker, Fred Fändrich, J. Hertreiter, Annette Fisseler‐Eckhoff, Christoph Frank Dietrich, M. Löhnert, C. A. Jacobi, K. Tischbirek, Benedikt Linz, Heike Scheithauer, Andreas de Weerth, S. M. Freys, F Pommerenke, Gisela Jülich, Reinhold Schmidt, W. Mellin, Markus Heckmann, Frank Zimmermann, A. Kröber, Eric J. Brunner, Ludger Leifeld, M. Pothmann, Markus Moehler, Claus Belka, Martin E. Kreis, Andreas Krüll, JW Mall, W. A. Rau, Thomas Fietz, Catherine Schuster, Heike Schieder, P. Schmidkonz, Wolf O. Bechstein, Nico Merkle, Mareile Joka, V. Ghilescu, Michaela Beer, Jütta Lüttges, Kurt Werner Schmid, St. Mose, Utz Settmacher, H. Gollub, Marian Grade, C. Jäger, Susanne Hamann, G Allmendinger, André Buchali, Rouven Berndt, Matthias Menig, S. Altmann, Dirk Hempel, P. Hirnle, H.-P. Dienes, L Claeys, J. Heimbucher, Christiane Falge, Christian Hertkorn, F. Dombrowski, Katja Schubert, Maximilian Knoll, Stefan Zeuzem, Cassandra L. Thiel, Rudolf Pihusch, F. Erckmann, R. Andreesen, Henriette Golcher, R. Jany, Andreas Thalheimer, T. Nüsse, Michael Flentje, B. Schoenfeld, Madeleine Müller, Signe Westring Worm, Gunar Günther, Bettina Peuser, Gerhard Müller, H. Schmidberger, Clemens Albrecht, Waldemar Krings, C. Gog, Georg Wittkowsky, Hauke Lang, Ursula Kronawitter, Robert Dengler, Gisela Klein, Matthias Harloff, Jörg Schröder, Waldemar Uhl, C. Wittekind, Florian Lordick, Rachel N. Pauls, J. Weinkauf, E. Eypasch, Bernhard Willibald Renz, Hans‐Peter Günther, J. Koebe, Beate Steiner, Jobst Greeve, Imke Ehlers, Petra S. Niemann, Stefan Riedl, Eric Hack, Ralf‐Dieter Hofheinz, U. Raute-Kreinsen, J. Caselitz, E. Wagner-Thiessen, U Römmele, Martina Stauch, U. Sulkowski, Frank Griesinger, P. Benkel, Richard Viebahn, A. Papyan, A. Hellinger, M. Stolte, W. Meyer, H. Bonhag, C. James Kirkpatrick, E. Erler, Heather Grimm, Bernd Hertenstein, Giuliano Ramadori, Peter Groß, Monika Betzler, R. Secknus, D. Mainka, G. Klöppel, M. Björnsgard, Bernd Hinrichs, Erum A. Hartung, W Berberich, Andreı̈ Szöke, E. Klar, C. Ruelfs, D. Henne-Bruns, G. Stöhr, Jutta Welzel, Werner Freier, Jens Kern, Jessica Buck, U. Abele, G. Hübner, Hanalise V. Huff, Griffin L. Michl, Martin Steder, M. Sohm, Gerhard G. Grabenbauer, K. Weigang-Köhler, Alois Fürst, Markus Bernhardt, Martin Werner, Th. Hager, A. Distelrath, Margarethe Geiger, Barbara König, Florian Schilcher, Maurizio Schmid, Andrea Tannapfel, Peter Gaßmann, R. Horstmann, Andrea Frilling, B. Heinrich, Michael Geißler, O. Brudler, J. Niehaus, M. Gofferje, R. Steinmann, C. Kölbel, H. Flach, B. Reers, M. Sure, D. Latz, C. Blumstein, Simone Reu, U Freund, W. Grimminger, M. Scheruhn, L. Mohr, Peter Rexrodt, J. Stern, Martin Schilling, M. Richthammer, Monic Dawel, Gabi Reichenbach, Ullrich Graeven, M. Gundlach, A. Hermann Müller, Heribert Stauder, Marc S. Raab, Volker Kunzmann, W. Lindemann, Marco Arndt, Martin Stuschke, W Dressler, Fred R. Hirsch, H. Albert Gilg, J Schorcht, M. Alfrink, Hans J. Schlitt, H. Zwicker, Carsten Boltze, Ludwig Keilholz, G. Puchtler, Michael van Kampen, Jens Köhler, R. Voigtmann, G. Matnjani, Thomas Wagner, Alfons Kreczy, Markus Albertsmeier, Walter Asperger, Jürgen Dunst, E. Breunig, André L. Mihaljević, U. Vehling-Kaiser, Sofie Franzén, Jens Kuhlgatz, Willie L. Ruff, S. Teyssen, T. Sprinz, Jörg Hombrink, Bernd Rosien, U. Banhardt, Wolfgang Schneider-Kappus, Jens Wallmichrath, S. Hochdörfer, Marcel Ebeling, Akram Gharbi, R. Raab, Michał Wysocki, W. Gödderz, Andreas Stallmach, J. Spes, H. Böhner, E. Kleimann, Ute Zimmermann, Andreas D. Rink, K. Hinkeldey, Grant M. Fischer, Guido Hildebrandt, Udo Lindig, R. Wilkowski, Andreas Schüler, Anne M. Neubauer, Ruth Baumgartner, V. Bürkle, Ingrid Becker, H.D. Böttcher, Gabrielle Strobel, Martin Görner, W. Hansi, E. Sebastian Debus, Paul W. Ackermann, Dorothea Utzig, B. Kimmig, M. Raute, Paul Schwenger, E. Köhler, K. Severin, H. Rahmer, Rudolf Schlag, Fritz Lindemann, Idan Blum, Jörn Sträter, Wolfgang Sendt, K. Henneking, Ulrike Stark, Hans-Joachim Wypior, Christian Rübe, J. Roder, Andrea Kerkhoff, Bernd Stengel, E. Dühmke, Stefan Meyer, H. Kastendieck, Veit Krenn, Rita Engenhart‐Cabillic, H.W. Hoffmanns, P. M. Markus, Thomas Wilhelm, B. Rosskopf, Rebecca Bücker, Sabine Köst, D. Jacob-Heutmann, W. Dornoff, J. Sistermanns, Teresa Kauke, Thomas Sudermann, Normann Willich, Susanne Lang, P. Ortloff, Matthias Hipp, H. Knipp, P. Vierling, Gregory Obst, Sebastian Eidt, Dietmar Borchert, Claus-Dieter Heidecke, Matthias Kraemer, H Löhr, Robert Michael Hermann, T. Rau, Detlef K. Bartsch, U Ritter, Ludwig Woidy, G. Spiessl, Wolff Schmiegel, Sabine Müller, Stefan Klein, A. Preiss, Antje Fahrig, Jan Wierecky, Ludwig Fischer von Weikersthal, Bernd Sido, Jürgen Tepel, Yuna Blum, Malte Sahrhage, C. Steinbrecher, Roland Göb, K. Wittchen, B. Göttler, Nihad Sardoschau, P. Langenscheidt, Theofilos G. Papadopoulos, Thomas Richter, Peter Reimer, Markus M. Lerch, M. Müller, Thomas Manger, Andreas Löcken, Michaela Plath, Hans Christiansen, Frank Bruns, Martin Wilhelm, Margot Zöller, Friedrich Kallinowski, Michael Schenk, Christian Reiter, M. Jung, Klaus Ziegler, Klaus‐Ulrich Däßler, A. Sendler, G. Heil, Roohi Gupta, Gottfried Dölken, Peter Mӧller, S. Schmitz, H. Ostertag, Werner Hohenberger, Markus K. A. Herrmann, Hans‐Detlev Saeger, M. Rothmund, K.-H. Berghäuser, Horst J. Koch, Rainer M. Bohle, Hedwiga Kerner, H.-P. Bruch, Rolf‐Peter Henke, Jürgen Siebler, K Ruffert, Christoph Schulz, E. Stüber, Elisabeth Rösler, C.F. Hess, B. Krebs, B Sievers, T. Kirchner, Mathias Freund, W. Permanetter, W Berdel, CONSTANZE VOGEL, T Südhoff, C Fellbaum, W Horn, Rolf Sauer, Ertan Mergen, Hermann Einsele, Michaela Ott, Franz J. Prott, K Ludwig, J. Zieren, B. Steinke, G Späth, Martin L. Hansmann, Ferdinand Hofstädter, D. Meyer, K. Kraft, Karl‐Heinz Heider, Markus Bangerter, D. Ockert, Peter H. Wünsch, Kurt Baier, A.-R. Fischedick, Horst Jürgen Feldmann, G. Seipelt, Eray Gökkurt, B. Jany, J. Weniger, R. Ott, M.K. Schilling, H. Nizze, Harald Biersack, H Kasper, Christoph‐Thomas Germer, Marc Alexander Brockmann, Wolfgang E. Schmidt, Judy R. Kersten, Heinz Höfler, M. Heinrich Seegenschmiedt, Stefan U. Christl, C. Kuntz, Bianca Schwarz, G Fuchs, Alfred C. Feller, K. T. E. Beckurts, R. Roscher, R. Funck, Hendrik A. Wolff, E. Horst, S. Seeber, O Opitz, D. Katenkamp, K. Schoppmeyer, G. Becker, R.-D. Kortmann, L. Füzesi, Volker Runde, G. Ruf, P. Wendling, W. Böcker, K. Diebold, M. Otto, Klaus Fenchel, J U Alles, Martin Fein, P Zonča, Christian Lerchenmüller, Steffen Mühldorfer, K. Höffken, Bernhard Opitz, A. Grote-Metke, H. Rau, Karl-Heinz Pflüger, A. A. Fauser, Thomas Herrmann, W. Zeller, Jörg Kriegsmann, Karl‐Friedrich Bürrig, K. Willborn, H. Rothe, S. Hauptmann, Christoph-Thomas Germer, A. Peter M. Heintz, G. Adler, M. Henke, E. Schippers, P Ritter, L. Tietze, R. Schlemminger, C.-H. Köhne, G. Omlor, Prof. Arthur Schüller, K.H. Link, K H Kloetzer, H.‐G. Höffkes, U. Kania, H. K. Müller-Hermelink, R. Moll, B. Schönberger, D Jaspersen, Jan Niklas Ahrend, Torsten Schorp, K. Heuche, J. Neuhäußer, B. Labinski, C. Meyer zum Büchenfelde, E. Buckisch-Urbanke, D. Weye, B. Röscheisen-Hellkamp, A. Roeder-Bock, S. Güntheroth, W. Gnann, T. Grötschla, H. Pollom, S. Tzonos, E. Hagenreiner, A. Hostege, Verena Ebner, H. Kottsieper, P. Tatsis, W. Fokuhl, H. Boje, K. Hubrich, M. Lara-Valverde, X. Sitskaia, A. M. Maus-Delgado, C. Zigouris, H.-J. Düwel, H. Hellfritzsch, W. Wannack, N. Alymov, U. Schevoigt, J. Dimitrion, U. Irmgart, H.-T. Doebl, T. Sajdova, M. Gluth-Stender, R. Dworzanski, J. Westheider, V. Hoffmann-Schneider, U. Ripper, F.-J. Peveling-Oberhag, F. Ertl, G. Glasbrenner, C. Orthney, S. Wartenberg, R. Slawik, J. Gerbl, J. Netteler, A. P. Düssel, C. Rottmann-Ickler, E. Gliesing, B. Dang-Lieu, M. Wickermeier-Dickel, A. Lüddeke
article en
3 citations

Abstract

Low anterior resection (LAR) and abdominoperineal resection (APR) are the two main surgical procedures after preoperative chemoradiotherapy (CRT) for locally advanced rectal cancer. APR is associated with poorer prognosis; however existing data do not consider intensified CRT (5-Fluorouracil (5-FU)/Oxaliplatin + radiation) protocols. Clinicopathological data of patients treated with APR and LAR from the CAO/ARO/AIO-04 trial were analysed in terms of prognostic parameters and quality of life (QoL). Based on higher response rate after intensified CRT, subgroup analyses were performed. Data from n = 1173 patients were assessed. APR after preoperative CRT was associated with a significantly worse overall survival (p = 0.0056), disease-free survival (p < 0.0001) and local recurrence rate (p = 0.0047). Clinicopathological data including clinical T stage (p < 0.000001), grading (p = 0.0038), postoperative lymph node (LN) positivity (p = 0.013), and number of positive LN (p = 0.0049) significantly differed between procedures and showed higher values in APR patients. The quality of total mesorectal excision (TME) was significantly better (p < 0.0001) and complete resection rates were higher (p = 0.0022) in LAR compared to APR patients. Subgroup analyses showed worse LR rates in APR patients after standard CRT (5-FU mono and radiation) but not after intensified CRT. After 3 years, role functioning (p = 0.019) and physical functioning (p = 0.001) had a slightly poorer outcome in APR patients. The poorer prognosis of patients undergoing APR for locally advanced rectal cancer may be explained by clinicopathological characteristics. Intensified CRT may compensate for the higher risk of LR after APR in patients with worse TME quality. QoL in APR patients was comparable to LAR patients.

Scientific ReportsVol. 15(1)
Goethe University Frankfurt (DE), University of Hildesheim (DE), Universität Hamburg (DE), University of Cologne (DE), Johannes Gutenberg University Mainz (DE), University of Applied Sciences Landshut (DE), University of Würzburg (DE), Universitätsklinikum Gießen und Marburg (DE), Universitätsmedizin Greifswald (DE), University Medical Center Freiburg (DE), University Hospital Augsburg (DE), Bayreuth Medical Center (DE), TUM Klinikum (DE), University Hospital Regensburg (DE), Medizinische Hochschule Hannover (DE), Asklepios Klinik Altona (DE), Krankenhaus der Barmherzigen Brüder Trier (DE), Universitätsklinikum Erlangen (DE), Asklepios Fachklinikum Brandenburg (DE), Elisabeth-Krankenhaus Essen (DE), Helios Amper-Klinikum Dachau (DE), ift Rosenheim (DE), Messer (Germany) (DE), Krankenhaus vom Roten Kreuz (DE), Ortenau Klinikum (DE), SRH Wald-Klinikum Gera (DE), Universitätsklinikum des Saarlandes (DE), St. Elisabeth-Krankenhaus Leipzig (DE), GKN (Germany) (DE), Marienhospital Stuttgart (DE), KRH Klinikum Nordstadt (DE), Evangelisches Krankenhaus Kalk (DE), Nuremberg Hospital (DE), Ansbach University of Applied Sciences (DE), Marienkrankenhaus Kassel (DE), Alb Fils Kliniken (DE), Ambulatory Rehabilitation Center Berlin Adlershof (DE), St. Josefs Hospital (DE), University Hospital Münster (DE), Krankenhaus St. Elisabeth und St. Barbara (DE), Ihre-Radiologen (DE), Medical Mission Institute (DE), Zentralklinik Bad Berka (DE), Katholisches Krankenhaus St. Johann Nepomuk (DE), St. Bernward Krankenhaus (DE), Kliniken Maria Hilf (DE), University Medical Center Hamburg-Eppendorf (DE), Klinikum Oldenburg (DE), Vivantes Klinikum (DE), Krankenhaus der Augustinerinnen (DE), Universitätsklinikum Knappschaftskrankenhaus Bochum (DE), University Hospital Schleswig-Holstein (DE), Universitäts Hautklinik Kiel (DE), BDH-Klinik Hessisch Oldendorf (DE), St. Marien Hospital (DE), Universitätsmedizin Göttingen (DE), Klinikum Esslingen (DE), Essen University Hospital (DE), München Klinik (DE), Klinikum Südstadt Rostock (DE), Krankenhaus Barmherzige Brüder (DE), Universitätsklinik für Strahlentherapie (DE), Krankenhaus Dresden-Friedrichstadt (DE), Klinikum Mutterhaus der Borromäerinnen (DE), University Hospital Leipzig (DE), Pius Hospital Oldenburg (DE), Universitätsklinikum Würzburg (DE), Lungenklinik Köln-Merheim (DE), Hegau-Bodensee-Klinikum Singen (DE), Klinikum Dortmund (DE), RoMed Kliniken (DE), Klinikum Coburg (DE), Center for HIV and Hepatogastroenterology (DE), Klinikum Bielefeld (DE), Brüderkrankenhaus St. Josef Paderborn (DE), Klinikum Fürth (DE), Clemenshospital Münster (DE), St. Vincenz-Krankenhaus Limburg (DE), Krankenhaus Nordwest (DE), Jena University Hospital (DE), Hospital zum Heiligen Geist (DE), Praxis für Humangenetik (DE), Universitätsmedizin Rostock (DE), Sophien-und Hufeland Klinikum (DE), Schwarzwald-Baar Klinikum (DE), Asklepios Klinik Weißenfels (DE), Elbe Kliniken Stade-Buxtehude (DE), Klinik Donaustauf (DE), Helios Kliniken (DE), St. Josef-Hospital (DE), Asklepios Klinikum Harburg (DE), Praxis für Hämatologie und Onkologie (DE), BG University Hospital Bergmannsheil Bochum (DE), Franziskus-Krankenhaus Berlin (DE), Caritas-Krankenhaus Bad Mergentheim (DE), Raphaelsklinik Münster (DE), Rosenheim Technical University of Applied Sciences (DE), Evangelisches Diakoniekrankenhaus (DE), Stiftung Juliusspital (DE), Evangelisches Krankenhaus Hamm (DE), St.-Johannes-Hospital Dortmund (DE), Rotkreuzklinikum München (DE), Marienhospital Gelsenkirchen (DE), Helios Klinikum Erfurt (DE), Centrum für Integrierte Onkologie (DE), Krankenhaus Porz am Rhein (DE), St. Franziskus Hospital (DE), Klinikum Kassel (DE), Klinikum Passau (DE), Alfried Krupp Hospital (DE), Emissions Reduzierungs Concepte (Germany) (DE), Klinikum St. Marien Amberg (DE), University Hospital in Halle (DE), Diakonie-Klinikum Stuttgart (DE), Klinikum Bremen-Mitte (DE), Klinikum Saarbrücken (DE), Städtische Kliniken Mönchengladbach (DE), University Hospital Cologne (DE), Krankenhaus St. Joseph-Stift Bremen (DE), Orthopädische Praxis (DE), HELIOS Albert-Schweitzer-Klinik Northeim (DE), University Hospital Ulm (DE), Siloah St. Trudpert Klinikum (DE), University Medical Centre Mannheim (DE), Klinikum Fulda (DE), Caritas-Krankenhaus St. Josef (DE), Bundeswehrkrankenhaus Ulm (DE), University Hospital Carl Gustav Carus (DE), Zentrum für Pathologie und Zytodiagnostik (DE), Klinikum Wilhelmshaven (DE), Klinik und Poliklinik für Psychotherapie und Psychosomatik (DE), Medias Klinikum (DE), Technical University of Munich (DE), University of Göttingen (DE), Ludwig-Maximilians-Universität München (DE), University of Lübeck (DE)
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