title: Mortality risk after preoperative versus postoperative chemotherapy and radiotherapy in lymph node-positive rectal cancer.
abstract: BACKGROUND
  Persistent lymph node-positive disease after preoperative radiotherapy for rectal cancer is associated with adverse outcomes. We quantified mortality risks of persistent pathologic lymph nodes in lymph node-positive rectal cancer patients treated with preoperative versus postoperative chemoradiation.
  
  
  METHODS
  This was a retrospective population-based analysis of 2,038 patients with stage III rectal cancer diagnosed 1994-2005 with follow-up through 2007 using data from the California Cancer Registry. Survival estimates were generated using the Kaplan-Meier method. Multivariate cancer-specific and overall mortality analyses were performed using Cox proportional hazard ratios with adjustment for age, gender, race/ethnicity, tumor grade, T stage, N stage, socioeconomic status, and time period (1994-1997, 1998-2001, and 2002-2005).
  
  
  RESULTS
  Overall survival was higher among lymph node-positive patients receiving postoperative chemoradiation compared to lymph node-positive patients receiving preoperative chemoradiation (median overall survival = 87 versus 62 months, P = 0.0002). In adjusted analyses, patients with persistent lymph node-positive disease after preoperative chemoradiation treatment had increased overall (HR = 1.69; 95 % CI, 1.42-2.01) and CRC-specific (HR = 1.78; 95 % CI, 1.44-2.19) mortality risk compared to lymph node-positive disease after postoperative chemoradiation treatment.
  
  
  CONCLUSIONS
  Stage III rectal cancer patients with persistent pathologic lymph nodes after preoperative chemoradiation represent a high-risk group, with higher mortality than those treated with postoperative chemoradiation.
authors.affiliation: Chao Family Comprehensive Cancer Center, University of California, Irvine, CA, USA.
authors.forename: Tara E
authors.initials: TE
authors.lastname: Seery
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ziogas
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Lin
authors.forename: Chuan-Ju G
authors.initials: CJ
authors.lastname: Pan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stamos
authors.forename: Jason A
authors.initials: JA
authors.lastname: Zell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011300:Preoperative Care; D011379:Prognosis; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult