Defining and predicting early recurrence in patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy.

Abstract

BACKGROUND:

The definition of "early recurrence (ER)" after rectal cancer surgery is currently unclear.

OBJECTIVE:

To determine an evidence-based cut-off to distinguish early and late recurrence (LR) for patients with rectal cancer and compare the clinicopathological factors between the two groups.

METHODS:

Patients who underwent neoadjuvant chemoradiotherapy (nCRT) and radical resection for locally advanced rectal cancer were included. A minimum p-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into ER and LR groups based on overall survival. A logistic regression model was used to assess risk factors for ER.

RESULTS:

A total of 763 patients were included, of which 167 (21.9%) experienced recurrence. The optimal cut-off value of recurrence-free survival to differentiate between ER (n = 125, 74.9%) and LR (n = 42, 25.1%) was 24 months (P = 0.000001). The median postrecurrence survival of ER and LR was 12 months and 22 months, respectively (p = 0.028). The most common recurrent sites in patients with ER and LR were lung metastases, the incidence of liver metastases, however, differed considerably in ER and LR (27.2% vs 9.5%, P = 0.019). Risk factors including elevated preoperative carcinoembryonic antigen (CEA), higher ypTNM stage, positive circumferential resection margin (CRM), and perineural invasion were significantly associated with ER.

CONCLUSION:

A recurrence-free interval of 24 months is the optimal cut-off value for defining ER versus LR. Elevated preoperative CEA, higher ypTNM staging, positive CRM, and perineural invasion were associated with ER of locally advanced rectal cancer.

• Authors: Zhifang Zheng, Xiaojie Wang, Ying Huang, Xingrong Lu, Zhekun Huang, Pan Chi
• Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology (Eur J Surg Oncol) Vol. 46 Issue 11 Pg. 2057-2063 (11 2020) ISSN: 1532-2157 [Electronic] England
• PMID: 32782202 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Chemical References

• Carcinoembryonic Antigen

Topics

• Adult
• Aged
• Carcinoembryonic Antigen (blood)
• Carcinoma (blood, pathology, secondary, therapy)
• Chemoradiotherapy
• Disease-Free Survival
• Female
• Humans
• Liver Neoplasms (secondary)
• Lung Neoplasms (secondary)
• Male
• Margins of Excision
• Middle Aged
• Neoadjuvant Therapy
• Neoplasm Invasiveness
• Neoplasm Recurrence, Local (epidemiology)
• Neoplasm Staging
• Proctectomy
• Prognosis
• Rectal Neoplasms (blood, pathology, therapy)
• Risk Factors
• Time Factors