Prognostic factors affecting recurrence and survival in patients with locally advanced rectal cancer

Purpose: This study aimed at investigating the factors that are likely to affect recurrence and survival in patients with locally advanced rectal cancer. Methods: The study included patients treated and followed-up between January 1999 and August 2009. Patient and disease data were retrieved from the patients' hospital charts. Results: A total of 221 patients were evaluated. Their median age was 58 years (range 18-83); 69 (31.2%) patients had clinical stage II and 152 (68.8%) clinical stage III. Median follow-up was 40 months (range 8-136). Median disease-free survival (DFS) was 77 months and median overall survival (OS) 95 months. The factors affecting local recurrence were pathological lymph node involvement (pN+), pathological T4 (pT4) tumors, and postoperative high serum level of carcinoembryonic antigen (CEA). pN (+) tumors, postoperative high serum CEA level, and perineural invasion increased the risk of both local and distant metastasis. The factors affecting mortality were pN+ tumors, pT4 tumors, poor tumor differentiation, high postoperative CEA level, age > 60 years, and no postoperative adjuvant chemotherapy (CT). The factors affecting DFS were pN+ tumors, pT4 tumors, poor tumor differentiation, postoperative high serum CEA level, perineural invasion, and surgical margin positivity. The factors affecting OS were pN+ tumors, postoperative high serum CEA level, poor tumor differentiation, perineural invasion and no adjuvant CT. Conclusion: Some prognostic factors are important in the assessment of prognosis of locally advanced rectal cancer.