Prognostic factors affecting short-term outcome of curative rectal cancer resection

Ta-Wen Hsu^a, Chang-Kuo Wei^a, Wen-Yao Yin^a, Chun-Ming Chang^a, Wen-Yen Chiou^b, Moon-Sing Lee^{b, c}, Hon-Yi Lin^{b, c}, Yu-Chieh Su^{c, d}, Hsin-Ju Lu^e, Shih-Kai Hung^{b, c},

^a Department of General Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^b Department of Radiation Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^c School of Medicine, Tzu Chi University, Hualian, Taiwan
^d Department of Hematological Oncology, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
^e Division of Teaching, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan

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Abstract
Objectives

The aim of this study was retrospectively to identify tumor characteristics or any other prognostic factors that influence disease survival after curative rectal cancer resection.

Patients and Methods

The records of 95 patients with Stages I, II, or III rectal cancer (TNM system) seen from August 2008 to June 2012 in one institution were reviewed. The patients underwent radical surgery (abdominoperineal resection or laparoanterior resection with lymph node dissection) as definitive therapy and then adjuvant treatment if pathology indicated T3 or T4 lesions, lymph node involvement, or positive margins. Radiation therapy (54 Gy) was delivered to the gross tumor volume and 45–50 Gy to the nodal region. The chemotherapy protocol consisted of 12 biweekly courses of oxaliplatin (85 mg/m2), 5-fluorouracil (FU) (400 mg/m2), and leucovorin (400 mg/m2) on Day 1, followed by continuous infusion of 5-FU (2400 mg/m2) for 48 hours.

Results

The 3-year cumulative overall survival rates for Stages I, II, and III rectal cancer were 100%, 100%, and 75%, respectively. Univariate analysis for all 91 patients indicated that pN classification, stage, surgical margin ≤ 10 mm, and extracapsular spread (ECS) were significantly associated with overall survival. The pN classification and stage also significantly affected the disease-free survival and distant metastasis-free survival. Furthermore, univariate analysis indicated vascular permeation, neural invasion, and surgical margin ≤ 10 mm were significantly associated with disease-free survival. Vascular permeation also significantly affected distant metastasis-free survival. On multivariate analysis for all patients, pN classification and close surgical margin significantly affected disease-free survival.

Conclusion

The presence of lymph node involvement and close margins was associated with lower disease-free survival. More aggressive postoperative therapy is suggested for patients if these factors exist.

Keywords
Adjuvant treatment; Chemoradiotherapy; Prognostic factors; Radical resection; Rectal cancer