title: Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum.
abstract: The aim of the study was to estimate the long-term results and the prognostic value of clinical and pathological factors following R0 anterior resection with total mesorectal excision (TME). Ninety-eight consecutive patients with histologically confirmed rectal cancer were studied prospectively with five-year follow-up. Survival was calculated using the Kaplan-Meier method and differences between curves were tested by the log-rank test. Multivariate analysis was performed using the Cox regression model. Recurrence-free survival (RFS) was 63.6%. Mean time of recurrence was 13.8 months (range 3-38). Local recurrence rate was 7.8% with the mean time of 12.7 months (range 3-25). In univariate analysis Dukes' stage (RFS for stage: A=93.2%; B=53.8%; C=26.3%) and preoperative CEA serum level (s-CEA) (for s-CEA<or=5 ng/ml RFS=93.8%; for s-CEA>5 ng/ml RFS=5.9%) significantly influenced survival (P<0.005 and P<0.00001). These parameters were also found to be independent prognostic factors in multivariate analysis (P<0.05 and P<0.00001). Survival was worse in older female patients with low-localised poorly differentiated tumors; however, those variables had not significant impact on prognosis. Neither symptom duration nor mucinous histology was significantly related to survival. Using TME technique a low local recurrence rate resulting in improved survival can be achieved. Apart from clinicopathological staging, elevated s-CEA can identify patients with poor prognosis. In addition to TME adjuvant therapy for this high-risk group should be considered.
authors.affiliation: Second Department of Surgical Oncology, Lower Silesian Oncology Center, Wroclaw Medical University, Poland. szynglarewicz.b@dco.com.pl
authors.forename: Bartlomiej
authors.initials: B
authors.lastname: Szynglarewicz
authors.forename: Rafal
authors.initials: R
authors.lastname: Matkowski
authors.forename: Jozef
authors.initials: J
authors.lastname: Forgacz
authors.forename: Marek
authors.initials: M
authors.lastname: Pudelko
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Smorag
authors.forename: Jacek
authors.initials: J
authors.lastname: Dryl
authors.forename: Jan
authors.initials: J
authors.lastname: Kornafel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D012008:Recurrence; D012306:Risk; D016896:Treatment Outcome