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Risk Factors of Rectal Cancer Local Recurrence: Population-based Survey and Validation of the Swedish Rectal Cancer Registry.

Jörgren, Fredrik LU ; Johansson, R; Damber, L and Lindmark, Gudrun LU (2010) In Colorectal Disease 12. p.977-986
Abstract
Aim Despite advances in rectal cancer treatment local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method LR and survival rates of 4157 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results The five-year overall and cancer specific survival rates were 45% and 62%. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM-stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm, and 6% at 11-15 cm above the anal... (More)
Aim Despite advances in rectal cancer treatment local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method LR and survival rates of 4157 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results The five-year overall and cancer specific survival rates were 45% and 62%. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM-stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm, and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48-4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43-1.00)]. Preoperative RT prolonged time to LR but did not significantly influence survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR. Conclusions Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow-up for detection of isolated LR is important. Extended follow-up should be considered for patients treated with RT. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Colorectal Disease
volume
12
pages
977 - 986
publisher
Wiley-Blackwell
external identifiers
  • wos:000281953700005
  • pmid:19438885
  • scopus:79951539497
ISSN
1462-8910
DOI
10.1111/j.1463-1318.2009.01930.x
language
English
LU publication?
yes
id
03257760-7fb4-4859-b4f4-028392925ddc (old id 1412317)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/19438885?dopt=Abstract
date added to LUP
2009-06-03 13:14:18
date last changed
2018-11-21 20:48:59
@article{03257760-7fb4-4859-b4f4-028392925ddc,
  abstract     = {Aim Despite advances in rectal cancer treatment local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method LR and survival rates of 4157 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results The five-year overall and cancer specific survival rates were 45% and 62%. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM-stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm, and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48-4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43-1.00)]. Preoperative RT prolonged time to LR but did not significantly influence survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR. Conclusions Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow-up for detection of isolated LR is important. Extended follow-up should be considered for patients treated with RT.},
  author       = {Jörgren, Fredrik and Johansson, R and Damber, L and Lindmark, Gudrun},
  issn         = {1462-8910},
  language     = {eng},
  pages        = {977--986},
  publisher    = {Wiley-Blackwell},
  series       = {Colorectal Disease},
  title        = {Risk Factors of Rectal Cancer Local Recurrence: Population-based Survey and Validation of the Swedish Rectal Cancer Registry.},
  url          = {http://dx.doi.org/10.1111/j.1463-1318.2009.01930.x},
  volume       = {12},
  year         = {2010},
}