Rate of Pulmonary Metastasis Varies with Location of Rectal Cancer in the Patients Undergoing Curative Resection
- 305 Downloads
Precise understanding of recurrence patterns permits efficient surveillance and effective treatment strategies. The aim of this study was to evaluate recurrence patterns after treatment of rectal cancers, specifically with respect to tumor location and chemoradiotherapy (CRT).
A single-institution, retrospective cohort of 2,086 consecutive rectal cancer patients, was enrolled between January 2000 and December 2007. All the patients underwent curative operations (R0). Tumor location was classified into lower (≤5 cm), middle (>5 to ≤8 cm), and upper (>8 cm) groups based on the distance of the inferior tumor border from the anal verge; the patients were also characterized according to whether they received preoperative/postoperative CRT.
The lung was the most common recurrence site in the lower group (lower vs. middle/upper; 14.6 vs. 8.9 %/8.0 %, P = 0.001/0.001). Recurrence patterns were not associated with receipt of preoperative/postoperative CRT. Additionally, RT and CRT did not reduce the rate of pulmonary recurrence (no-RT/preoperative CRT/postoperative CRT, 37.5/37.9/42.6 %; P = 0.13). In a multivariate analysis, preoperative level of serum carcinoembryonic antigen, abdominoperineal resection, advanced T category, N category, and circumferential resection margin were identified as independent risk factors for pulmonary recurrence in all groups. Otherwise, low rectal cancer was associated with unresectable pulmonary recurrence (RR = 2.19; 95 % CI 1.012–3.072; P = 0.04).
Neither RT nor CRT affects the pattern and rate of recurrence. Tumor location specifically affects recurrence in rectal cancer patients, such that the lower group is a risk factor for unresectable pulmonary recurrences.
KeywordsRectal Cancer Circumferential Resection Margin Lower Rectal Cancer Recurrence Pattern Systemic Recurrence
Authors specially appreciate Dr. Kim JH for his dedication to validate histologic findings and clinical staffs in the Colorectal Division (Drs. Lim SB, Kim CW, Park IJ, and Yoon YS) for the valuable provision of clinical database.
This study was supported by Grants (to J.C. Kim) from the Asan Institute for Life Sciences (2014-69), the Korea Research Foundation (NRF-2013R1A2A1A03070986), Ministry of Science, ICT, and Future Planning, the Korea Health 21 R&D Project (HI06C0868 and HI13C1750) and the Center for Development and Commercialization of Anti-Cancer Therapeutics (HI10C2014), Ministry of Health and Welfare, Republic of Korea.
- 24.Cercek A, Goodman KA, Hajj C et al (2014) Neoadjuvant chemotherapy first, followed by chemoradiation and then surgery, in the management of locally advanced rectal cancer. J Natl Compr Cancer Netw 12:513–519Google Scholar