title: Combined-modality therapy with sphincter-preserving total mesorectal excision for locally advanced rectal cancer: patient's age and long-term outcome.
abstract: BACKGROUND
  In rectal cancer patients anterior resection with total mesorectal excision (TME) results in good functional outcomes, optimal local control and improved survival. However, patients with locally advanced tumours still have a high risk of oncological relapse and may benefit from neo- or adjuvant therapy. AIM. The purpose of this study was to identify the clinico-pathological features related to poor prognosis after sphincter-saving curative combined-modality therapy for rectal cancer.
  
  
  METHODS
  Forty-eight consecutive patients with UICC stage II and III rectal carcinoma operated on with TME were studied prospectively. Fifteen patients received neoadjuvant radiotherapy and postoperative chemotherapy; for the remainder combined adjuvant chemoradiotherapy was given.
  
  
  RESULTS
  Five-year cancer-specific survival rate was 49%. Patient's gender, tumour location, grade, mucinous histology, direct tumour spread, type of growth margin and lymphocytic tumour infiltration were revealed to be factors without statistical importance. Only the positive nodal status (31.6 +/- 11.0 vs 61.5 +/- 9.7) and the patient's advanced age (38.5 +/- 9.7 vs 63.2 +/- 11.4) were significantly related to decreased survival rate (p=0.038 and 0.048, respectively). In multivariate analysis both parameters independently influenced poor prognosis (p=0.045 and 0.038; Relative Risk 2.26 and 2.13; Odds Ratio 4.21 and 1.07, respectively).
  
  
  CONCLUSIONS
  An elderly patient's age seems to be an independent prognostic factor associated with poor survival after curative treatment for locally advanced rectal cancer even when non-cancer causes of death are excluded. Thus, for older patients adjuvant therapy should be an integral part of treatment with the careful benefit-toxicity analysis.
authors.affiliation: 2nd Department of Surgical Oncology, Lower Silesian Oncology Center, Plac Hirszfelda 12 53-413 Wroclaw, 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: Adam
authors.initials: A
authors.lastname: Maciejczyk
authors.forename: Piotr
authors.initials: P
authors.lastname: Kasprzak
authors.forename: Jozef
authors.initials: J
authors.lastname: Forgacz
authors.forename: Marek
authors.initials: M
authors.lastname: Pudelko
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome