Outcome after curative resection for locally recurrent rectal cancer.
OBJECTIVE
Few biologic markers have been studied as prognostic factors in recurrent rectal carcinoma patients. We sought to determine the influence of clinical, pathologic, and biologic (p53, bcl-2, and ki-67) variables on survival after curative resection of locally recurrent rectal cancer.


METHODS
Retrospective review of patients with locally recurrent rectal cancer who received surgery with curative intent.


RESULTS
From 1988 to 1998, 134 patients with locally recurrent rectal cancer underwent operative exploration. Curative resection was performed in 85 patients. Median follow-up was 43 (range, 1.3-149) months. On multivariate analysis, negative predictors of overall survival included an elevated carcinoembryonic antigen level (P=0.02; hazard ratio 2.41; 95 percent confidence interval, 1.19-4.89) and an R1 resection margin (P = 0.01; hazard ratio, 2.81; 95 percent confidence interval, 1.27-6.21). In 26 patients for whom biologic variables were available, p53, bcl-2, and ki-67 did not significantly impact disease-specific survival or overall survival. Five-year disease-specific survival, overall survival, and pelvic control rates were 46, 36, and 51 percent respectively. Of the 50 patients who relapsed, time to second local recurrence was longer than time to development of metastasis (median, 16.5 vs. 9 months). Median survival for patients with metastatic recurrence was 26.l vs. 41.5 months for those with a subsequent local recurrence alone.


CONCLUSIONS
Approximately two-thirds of patients with locally recurrent rectal cancer can be resected for cure. Preoperative carcinoembryonic antigen and an R0 resection margin were the only significant predictors of overall survival. p53, bcl-2, and ki-67 did not impact survival outcomes.
Bedrosian
Isabelle
I
Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 444, Houston, Texas 77030, USA.
Giacco
Geoffrey
G
Pederson
Lee
L
Rodriguez-Bigas
Miguel A
MA
Feig
Barry
B
Hunt
Kelly K
KK
Ellis
Lee
L
Curley
Steven A
SA
Vauthey
Jean Nicolas
JN
Delclos
Marc
M
Crane
Christopher H
CH
Janjan
Nora
N
Skibber
John M
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000096:biosynthesis; D002272:Carcinoembryonic Antigen / Q000096:biosynthesis; D003082:Colectomy; D003131:Combined Modality Therapy; D005260:Female; D019254:Genes, bcl-2 / Q000502:physiology; D006801:Humans; D019394:Ki-67 Antigen / Q000096:biosynthesis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000378:metabolism* / Q000601:surgery*; D012004:Rectal Neoplasms / Q000378:metabolism* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000096:biosynthesis
D014408:Biomarkers, Tumor; D002272:Carcinoembryonic Antigen; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53