Radiat Oncol J.  2019 Jun;37(2):110-116. 10.3857/roj.2019.00199.

Risk factors for locoregional recurrence in patients with pathologic T3N0 rectal cancer with negative resection margin treated by surgery alone

• Baek JY
• Yu JI
• Park HC
• Choi DH
• Yoo GS
• Cho WK
• Lee WY
• Yun SH
• Cho YB
• Park YA
• Kim HC

• KMID: 2452571
• DOI: http://doi.org/10.3857/roj.2019.00199

Abstract

PURPOSE
This study aimed to identify prognostic factors for locoregional recurrence (LRR) in pT3N0 rectal cancer patients who were treated with surgery alone and had negative resection margin including circumferential resection margin (CRM) for optimal indication of adjuvant radiotherapy.
MATERIALS AND METHODS
We reviewed patients with pT3N0 rectal cancer who were treated via upfront surgery and had no other adjuvant treatment from January 2003 to December 2012. In total, 122 patients who had negative resection margin including negative CRM were included in the analysis.
RESULTS
The median follow-up period after surgery was 60 months (range, 3 to 161 months). During this time, 6 patients (4.9%) experienced LRR at the anastomotic site (4 patients), and regional lymphatic area (2 patients). The estimated 5-year rates of overall survival, recurrence-free survival, and LRR-free survival were 96.7%, 84.6%, and 94.0%, respectively. Multivariate analysis showed that level of tumor ≤5 cm was a significant prognostic factor for LRR-free survival (LRRFS) (p = 0.04; hazard ratio = 7.08; 95% confidence interval, 1.06-47.30). Patients with level of tumor ≤5 cm had an estimated 5-year LRRFS of 66.8%, which was much higher than 2.3% in patients with level of tumor >5 cm. There was no significant factor for recurrence-free survival or overall survival.
CONCLUSION
In T3N0 rectal cancer, adjuvant chemoradiotherapy should be recommended in patients with level of tumor ≤5 cm for better local control. However, in patients with pT3N0 disease, negative resection margin, and level of tumor >5 cm, adjuvant chemoradiotherapy should be carefully suggested.

Keyword

Rectal neoplasms; T3N0; Surgery alone

MeSH Terms

Chemoradiotherapy, Adjuvant
Follow-Up Studies
Humans
Multivariate Analysis
Radiotherapy, Adjuvant
Rectal Neoplasms*
Recurrence*
Risk Factors*