Stage I rectal cancer: identification of high-risk patients.
BACKGROUND
Stage I rectal cancer (T1, T2 N0) is currently treated by surgical resection alone. Despite adequate surgical resection, approximately 10-15% of patients will develop recurrence. Identification of patients at high risk for recurrence could potentially lead to an improvement in outcome by selection of these patients for adjuvant therapy.


METHODS
Between June 1986 and September 1996, 211 patients with primary rectal cancer (stage I) were treated by radical surgical resection alone. The medical data of all patients were entered into a database and prospectively followed. The following 10 prognostic factors were correlated with recurrence and tumor-related mortality: patient factors: age, gender, and preoperative carcinoembryonic antigen level; tumor factors: location from the anal verge (< 6 cm vs. > or = 6 cm), T stage (T1 vs. T2), intratumoral blood vessel invasion (BVI), intratumoral lymphatic vessel invasion, presence of tumor ulceration, and histologic differentiation; and treatment-related factors: extent of surgical resection--abdominal perineal resection versus low anterior resection. Univariate analysis of the effect of the prognostic factors on recurrence and tumor-related mortality were performed by the method of Kaplan-Meier and log rank test. Independent prognostic factors were determined by a multivariate analysis performed using the Cox proportional hazards model.


RESULTS
The overall 5-year actuarial recurrence was 12% and tumor-related mortality was 10%. Independent predictors of recurrence were male gender and BVI. Independent predictors of tumor-related mortality were male gender, BVI, and poorly differentiated tumors.


CONCLUSIONS
Despite radical resection, patients with stage I rectal cancer with male gender, BVI, and poorly differentiated tumors should be considered high-risk patients.
Blumberg
D
D
Department of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Paty
P B
PB
Picon
A I
AI
Guillem
J G
JG
Klimstra
D S
DS
Minsky
B D
BD
Quan
S H
SH
Cohen
A M
AM
D000005:Abdomen / Q000601:surgery; D000206:Actuarial Analysis; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000473:pathology; D000704:Analysis of Variance; D001808:Blood Vessels / Q000473:pathology; D002272:Carcinoembryonic Antigen / Q000032:analysis; D003131:Combined Modality Therapy; D019992:Databases as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000517:prevention & control; D009367:Neoplasm Staging; D018579:Patient Selection; D010502:Perineum / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014456:Ulcer / Q000473:pathology
D002272:Carcinoembryonic Antigen