title: Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer.
abstract: OBJECTIVE
  To identify predictive factors for locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) in patients treated with chemoradiation and surgery for rectal cancer.
  
  
  METHODS
  Between 1989 and 2001, 470 patients with rectal cancer were treated with preoperative (89%) or postoperative (11%) chemoradiation and mesorectal excision. Median radiation dose was 45 Gy; 97% received concurrent infusional 5-fluorouracil, and 65% received adjuvant chemotherapy. Median follow-up interval was 5.7 years.
  
  
  RESULTS
  The 5-year rates of freedom from LR, freedom from DM, and OS were 90%, 79%, and 80%, respectively. On univariate analysis, significant predictors of LR were female sex, clinical T stage, pathologic T and N stages, and positive radial margin. Significant univariate predictors of DM were circumferential extent of tumor, tumor immobility, lymphovascular invasion, perineural involvement, and pathologic T and N stages. Significant univariate predictors of lower OS were age, circumferential extent of tumor, shorter distance from anal verge, tumor size, tumor immobility, anal canal involvement, lymphovascular invasion, perineural involvement, positive radial margin, and pathologic T and N stages. On Cox multivariate analysis, female sex and pathologic T and N stages independently predicted for LR; pathologic T and N stages independently predicted for DM; and age, circumferential extent of tumor, positive radial margin, and pathologic T and N stages independently predicted for lower OS.
  
  
  CONCLUSIONS
  Pathologic T and N stages significantly predicted for all 3 end points (LR, DM and OS) on multivariate analysis. Investigations of more aggressive adjuvant chemotherapy appear warranted for pathologic stage T3/T4 or N1/2 rectal cancer.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. PrajDas@mdanderson.org
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: John M
authors.initials: JM
authors.lastname: Skibber
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Rodriguez-Bigas
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: George J
authors.initials: GJ
authors.lastname: Chang
authors.forename: Paulo M
authors.initials: PM
authors.lastname: Hoff
authors.forename: Cathy
authors.initials: C
authors.lastname: Eng
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Nora A
authors.initials: NA
authors.lastname: Janjan
authors.forename: Marc E
authors.initials: ME
authors.lastname: Delclos
authors.forename: Sunil
authors.initials: S
authors.lastname: Krishnan
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Levy
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ellis
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D012737:Sex Factors; D013534:Survival
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil