Prognostic factors for the time of occurrence and dynamics of distant metastases and local recurrences after radical treatment in patients with rectal cancer

摘要

Background: A remarkable increase has been noted in the rate of incidence of rectal cancer. Post- or preoperative adjuvant treatment has significantly decreased the risk of local recurrence, but still only about 50% of all patients with rectal cancer treated radically can achieve a permanent cure. The majority of failures are due to distant metastases (DM) and/or local recurrences (LR). The risk and dynamics of failure after treatment of neoplasmtic disease has been analyzed on several occasions.Material and methods: This retrospective study involved 161 consecutive patients with rectal cancer treated by radical surgery between 1972 and 1989. The mean age was 57 years. All patients underwent radical abdominoperineal rectum excision. The average follow-up was 10 years. In terms of the time elapsing to failure, the entire group of patients was divided into two subgroups: ‘early’ (occurring within 18 months after surgery) and ‘late’ (more than 18 months after surgery).Results: The actuarial 5-year disease-free survival rate was 61.3%. Distant metastases occurred in 42 cases (26%), of whom 50% developed ‘early’ relapses, whereas local recurrences (29 cases – 18%) developed ‘early’ in 72% of the cases. Male gender was found to be an independent factor increasing the risk of ‘early’ relapses, particularly in the pN2 group. The stage of the disease is an indisputable risk factor for distant metastases and ‘early’ local recurrences.Conclusion: The time to failure varied significantly regarding local and distant relapses, suggesting different dynamics and origin. It seems that aggressive systemic and local treatment may decrease the incidence of relapses and improve long-term results. There is an urgent need to define new prognostic factors for identifying patients threatened by early dissemination.