title: Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer.
abstract: BACKGROUND
  The purpose of the present study was to investigate risk factors associated with local recurrence in patients with locally advanced rectal cancer who received preoperative chemoradiotherapy in combination with total mesorectal excision (TME).
  
  
  METHODS
  Rectal cancer patients who were treated with neoadjuvant chemoradiation with TME were studied. We compared 26 patients who developed local recurrence with 119 recurrence-free patients during the follow-up period.
  
  
  RESULTS
  The median follow-up period was 52 months (range: 14-131 months). Based on the use of univariate and multivariate analyses, circumferential margin involvement (p = 0.02), the presence of lymphovascular or perineural invasion (p = 0.02), and positive nodal disease (p = 0.03) were contributing factors for local recurrence. The local recurrence rate was different between ypN(+) patients and ypN(-) patients with more than 12 nodes retrieved (p = 0.01). There was no difference in local recurrence rates between ypN(+) patients and ypN(-) patients with < 12 nodes (p = 0.35) or between ypN(-) patients with < 12 nodes or > or = 12 nodes (p = 0.18).
  
  
  CONCLUSIONS
  Patients with circumferential margin involvement, the presence of lymphovascular or perineural invasion, and positive nodal disease should be regarded as a high-risk group. We also determined that lymph node retrieval (< 12 nodes) in patients with node-negative disease was a risk factor for local recurrence.
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea. namkyuk@yuhs.ac
authors.forename: Nam-Kyu
authors.initials: NK
authors.lastname: Kim
authors.forename: Young-Wan
authors.initials: YW
authors.lastname: Kim
authors.forename: Byung-Soh
authors.initials: BS
authors.lastname: Min
authors.forename: Kang-Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung-Kook
authors.initials: SK
authors.lastname: Sohn
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Cho
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D012307:Risk Factors; D015996:Survival Rate