title: Influence of local recurrence on survival in patients with rectal cancer.
abstract: BACKGROUND
  Recent trials on rectal cancer have demonstrated significant improvements in local recurrence without improvements in overall survival. The aim of this paper was to define the influence of local recurrence on survival in a prospective series of patients who underwent R0 or R1 resections for rectal cancer.
  
  
  METHODS
  Patients presenting with rectal cancer from 1996 to 2012 were prospectively audited. The study included patients who underwent an R0 or R1 resection. Local recurrence was defined as cancer regrowth detected in the pelvis regardless of whether or not new metastases were found elsewhere. Kaplan-Meier curves, smoothed hazard functions and Cox models using both time since diagnosis and age as the time scale were used to define the influence of local recurrence on overall survival.
  
  
  RESULTS
  The study involved 483 patients, of mean age 66 years (standard deviation = 13) and a median follow-up of 5.2 years. The results at 5 years were overall survival 71% (95% confidence interval (CI) 66-75), local recurrence 7% (95% CI 5-10) and distant recurrence 18% (95% CI 14-22). Patients diagnosed with local recurrence died faster than patients diagnosed with either distant recurrence or no recurrence, and this was particularly obvious for younger patients (local hazard ratio (HR) 54, 95% CI 12-253 and distant HR19, 95% CI 4-80). Local recurrence that developed early following surgery also had worse survival outcomes.
  
  
  CONCLUSIONS
  Within this cohort of rectal cancer patients, the early development of local recurrence was the single most important indicator of a reduced survival, and carried a worse prognosis than the development of distant metastases alone.
authors.affiliation: Colorectal Cancer Unit, St John of God Hospital Subiaco, Perth, Western Australia, Australia; School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Cameron
authors.initials: C
authors.lastname: Platell
authors.forename: Katrina
authors.initials: K
authors.lastname: Spilsbury
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: local recurrence; overall survival; rectal cancer; survival