Retrospective analysis of 856 cases with stage 0 to III rectal cancer underwent curative surgery combined modality therapy / 中华外科杂志

ABSTRACT

<p><b>OBJECTIVE</b>To investigate the survival and prognostic factors of stage 0 to III rectal cancer in 10 years.</p><p><b>METHODS</b>Clinical data and follow-up of 856 rectal cancer patients with stage 0-III underwent curative surgery from January 2000 to December 2010 were retrospective analyzed. There were 470 male and 386 female patients, with a mean age of (58 ± 12) years. Kaplan-Meier method was used to analyze the overall survival and disease free survival. Log-rank test was used to compare the survival between groups. Cox regression was used to analyze the independent prognostic factors of rectal cancer.</p><p><b>RESULTS</b>The patients in each stage were stage 0 with 18 cases, stage I with 209 cases, stage II with 235 cases, and stage III with 394 cases. All patients received curative surgery. There were 296 patients evaluated as cT3, cT4 and any T with N+ received preoperative radiotherapy. 5.4% patients got pathological complete response (16/296), and the recurrence rate was 4.7% (14/296). After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up, the 5-year overall survival rate in stage 0 to I of was 91.0%, stage II 86.2%, and stage III 60.0%, with a significant difference (P=0.000). The cumulative local recurrence rate was 4.8% (41/856), of which 70.7% (29/41) occurred within 3 years postoperatively, 97.6% (40/41) in 5 years. The cumulative distant metastasis rate was 16.4% (140/856), of which 82.9% (129/140) occurred within 3 years postoperatively, 96.4% (135/140) in 5 years. The incidence of abnormal imaging findings was significantly higher in pulmonary than liver and other sites metastases (75.0% vs. 21.7%, χ² =25.691, P=0.000). The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs. 37.8%, χ² =25.691, P=0.000). Multivariable analysis showed that age (P=0.015, HR=1.385, 95% CI 1.066 to 1.801), surgical approach (P=0.029, HR=1.337, 95% CI 1.030 to 1.733), differentiation (P=0.000, HR=1.535, 95% CI 1.222 to 1.928), TNM stage (P=0.000, HR=1.349, 95% CI 1.260 to 1.444) and lymphovascular invasion (P=0.001, HR=1.715, 95% CI 1.258 to 2.342) are the independent prognostic factors for rectal cancer.</p><p><b>CONCLUSIONS</b>Age, surgical approach, differentiation, TNM stage and lymphovascular invasion are independent prognostic factors for rectal cancer. Preoperative evaluation and combined modality therapy can significant reduce the local recurrence and improve overall survival for rectal cancer patients.</p>