Impact of pre-treatment patient-related selection parameters on outcome in rectal cancer.
BACKGROUND
Preoperative radiotherapy (RT) for rectal cancer reduces local recurrence rates and possibly also mortality. Patient-related parameters such as age and comorbidity have a major impact on selection to preoperative RT. The aim of this study was to investigate how this selection influences the outcome in rectal cancer regardless of dose or fractionation of RT.


METHODS
Data from the Swedish Colorectal Cancer Registry and the Swedish National Patient Register on all patients without distant metastasis who underwent elective trans-abdominal surgery for rectal cancer 2000-2010 in the Stockholm-Gotland region was retrieved. Factors influencing survival and recurrence were identified by Cox regression analyses.


RESULTS
There were 2300 patients included. Among these 70.3% received preoperative RT. Three-year overall survival (OS), disease-free survival (DFS) and local recurrence rate were 80.2, 68.6 and 4.7%, respectively. All outcome measures were significantly improved over time. In a multivariable analysis in patients with comorbidity (Charlson comorbidity index score ≥1), OS were significantly better following preoperative RT than after surgery alone (HR 0.65, 95% CI 0.49-0.87). OS among patients with advanced age (≥80 years), was not influenced by preoperative RT.


CONCLUSIONS
OS among patients with comorbidity was better following preoperative RT than after surgery alone while no differences were seen among the elderly. This indicates that the selection process may be optimised for the patients with advanced age but comorbidity should be used cautiously for exclusion of patients from preoperative RT.
Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Solna, P9:03, 17176 Stockholm, Sweden. Electronic address: anders.hansson-elliot@karolinska.se.
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Elliot
Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Solna, P9:03, 17176 Stockholm, Sweden.
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Martling
Karolinska Institutet, Department of Oncology-Pathology (OnkPat) K7, Z4:01, Karolinska University Hospital, 17176 Stockholm, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Akademiska sjukhuset, 75185 Uppsala, Sweden.
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Glimelius
Karolinska Institutet, Department of Oncology-Pathology (OnkPat) K7, Z4:01, Karolinska University Hospital, 17176 Stockholm, Sweden.
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Johansson
Department of Molecular Medicine and Surgery, Karolinska Institutet and Center for Digestive Diseases, Karolinska University Hospital, Solna, P9:03, 17176 Stockholm, Sweden.
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Nilsson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015897:Comorbidity; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D012004:Rectal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery
Aged; Comorbidity; Radiotherapy; Rectal cancer; Recurrence; Survival