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. 2022 Nov 19;22(1):1196.
doi: 10.1186/s12885-022-10299-8.

Dentate line invasion as a predictive factor of poor distant relapse-free survival in locally advanced lower rectal cancer with anal sphincter involvement

Maxiaowei Song #  1 , Hongzhi Wang #  1 , Lin Wang  2 , Shuai Li  1 , Yangzi Zhang  1 , Jianhao Geng  1 , Xianggao Zhu  1 , Yongheng Li  3 , Yong Cai  4 , Weihu Wang  5
Affiliations

Dentate line invasion as a predictive factor of poor distant relapse-free survival in locally advanced lower rectal cancer with anal sphincter involvement

Maxiaowei Song et al. BMC Cancer. .

Abstract

Background: While an important surgical landmark of the dentate line has been established for locally advanced lower rectal cancer (LALRC), the prognostic significance of dentate line invasion (DLI) has not been well defined. This study aimed to explore the impact of DLI on prognosis in LALRC patients with anal sphincter involvement after neoadjuvant chemoradiotherapy followed by surgery.

Methods: We analyzed 210 LALRC patients and classified them into DLI group (n = 45) or non-DLI group (n = 165). The exact role of DLI in survival and failure patterns was assessed before and after propensity-score matching(PSM). Finally, 50 patients were matched.

Results: Before matching, patients in the DLI group had poorer 5-year distant relapse-free survival (DRFS) (P < 0.001), disease-free survival (DFS) (P < 0.001), and overall survival (OS) (P = 0.022) than those in the non-DLI group, with the exception of local recurrence-free survival (LRFS) (P = 0.114). After PSM, the 5-year DRFS, DFS, OS, and LRFS were 51.7% vs. 79.8%(P = 0.026), 51.7% vs. 79.8%(P = 0.029), 71.6% vs. 85.4%(P = 0.126), and 85.7% vs. 92.0%(P = 0.253), respectively, between the two groups. DLI was also an independent prognostic factor for poor DRFS with (Hazard ratio [HR] 3.843, P = 0.020) or without matching (HR 2.567, P = 0.001). The DLI group exhibited a higher rate of distant metastasis before (44.4% vs. 19.4%, P < 0.001) and after matching (48.0% vs. 20.0%, P = 0.037) and similar rates of locoregional recurrence before (13.3% vs.7.9%, P = 0.729) and after matching (16.0% vs.12.0%, P = 1.000).

Conclusions: DLI may portend worse DRFS and distant metastasis in LALRC patients with anal sphincter involvement, and this may be an important variable to guide clinicians.

Keywords: Dentate line; Failure patterns; Lower rectal cancer; Prognostic factor; Survival analysis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Survival analysis between DLI group (n = 45) and non-DLI group (n = 165) before propensity-score matching. a,b,c,d Kaplan‒Meier estimation of 5-year distant relapse-free survival (DRFS), disease-free survival (DFS), overall survival (OS), and local recurrence free survival (LRFS) between DLI group (n = 45) and non-DLI group (n = 165) before propensity-score matching. Abbreviation: DLI = dentate line invasion
Fig. 2
Fig. 2
Survival analysis between DLI group (n = 25) and non-DLI group (n = 25) after propensity-score matching. a,b,c,d Kaplan‒Meier estimation of 5-year distant relapse-free survival (DRFS), disease-free survival (DFS), overall survival (OS), and local recurrence free survival (LRFS) between DLI group (n = 25) and non-DLI group (n = 25) after propensity-score matching. Abbreviation: DLI = dentate line invasion
Fig. 3
Fig. 3
Forest plot of HRs for DLI versus non-DLI of LALRC with anal sphincter involvement in the subgroup analysis of distant relapse-free survival. Abbreviations: HRs = hazard ratios, DLI = dentate line invasion, DRFS = distant relapse-free survival, LALRC = locally advanced lower rectal cancer, CEA = carcinoembryonic antigen, c = clinical, ECOG = Eastern Cooperative Oncology Group. *Evaluated by pretreatment diagnostic biopsy. Low indicates well or moderately differentiated; high indicates poorly differentiated, mucinous, or signet ring cell carcinoma
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