Factors associated with local recurrence after neoadjuvant chemoradiation with total mesorectal excision for rectal cancer.
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.
Kim
Nam-Kyu
NK
Department of Surgery, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemun-gu, Seoul, 120-752, Korea. namkyuk@yuhs.ac
Kim
Young-Wan
YW
Min
Byung-Soh
BS
Lee
Kang-Young
KY
Sohn
Seung-Kook
SK
Cho
Chang-Hwan
CH
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