Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

Table 1 Patient characteristics n (%)

Variables	Patient
Gender
Male	54 (60)
Female	36 (40)
Age
≤ 60 yr	50 (55.6)
> 60 yr	40 (44.4)
Primary surgery
Anterior resection	54 (60)
Abdominoperineal resection	32 (35.6)
Hartmann	2 (2.2)
Local excision	2 (2.2)
Neoadjuvant chemoradiotherapy for primary tumor
Yes	18 (20)
No	72 (80)
Primary tumor stage
I	6 (6.6)
IIA	8 (8.8)
IIB	11 (12.2)
IIIA	10 (11.1)
IIIB	20 (22.2)
IIIC	26 (28.8)
Unknown	9 (10)
Serum CEA1
≤ 5 ng/mL	27 (30)
> 5 ng/mL	48 (53.3)
Unknown	15 (16.7)
Preoperative chemoradiotherapy for recurrent tumor2
Yes	10 (24.4)
No	31 (75.6)
Surgery for recurrent tumor	41 (45.6)
Anterior resection	2 (4.9)
Abdominoperineal resection	30 (73.2)
Combined organ excision3	5 (12.2)
Total pelvic exenteration	4 (9.8)
Conservative therapy	49 (54.4)
Resection status
R0	36 (40)
R1-2	5 (5.5)

¹The serum CEA level after recurrence;

²For the patients who underwent surgery;

³Including excision of uterus, vagina, seminal vesicle, prostate, and sacrum. CEA: Carcinoembryonic antigen.

Table 2 The association between recurrence pattern and resectability

Recurrence pattern	Resection rate (%)	P value	R0 rate (%)	P value
Axial	88.9 (24/27)	< 0.001	85.2 (23/27)	< 0.001
Anterior	33.3 (7/21)		33.3 (7/21)
Posterior	25 (2/8)		25 (2/8)
Lateral	21.7 (5/23)		4.3 (1/23)

The values shown are the resection rate expressed in %, with the number of patients with successful resection/total number of patients with locally recurrent rectal cancer in parentheses.

Table 3 Univariate analysis of risk factors affecting long-term survival

Variables	n	5 yr OS rate (%)	P value
Gender
Male	54	29.6	0.803
Female	36	33.3
Age
≤ 60 yr	50	26	0.187
> 60 yr	40	37.5
Surgery of primary tumor
Anterior resection	54	31.5	0.451
Abdominoperineal resection	32	31.2
Pathologic stage of primary tumor
I-II	25	33.3	0.473
III	56	30.8
Serum CEA1
≤ 5 ng/mL	26	38.5	0.35
> 5 ng/mL	49	28.6
Interval to recurrence (mo)
≤ 24	63	23.8	0.011
> 24	27	48.1
Recurrence pattern
Axial	27	63	< 0.001
Anterior	21	28.6
Posterior	8	12.5
Lateral	23	4.3
Surgery for recurrent tumor
R0 resection	36	55.6	< 0.001
R1-2 and non-surgery	54	14.8

¹The serum carcinoembryonic antigen (CEA) level after recurrence. OS: Overall survival.

Table 4 Multivariate Cox regression (backward method) of prognostic factors in relation to 5 year overall survival

Variables	Hazard ratio (95%CI)	P value
R0 resection	2.734 (1.212-6.168)	0.015
Recurrence pattern	1.078 (0.716-1.625)	0.718
Interval to recurrence	0.978 (0.953-1.004)	0.102
Gender	1.776 (0.870-3.625)	0.114
Age	0.657 (0.326-1.322)	0.239
Serum CEA	1.088 (0.447-2.647)	0.853
Primary tumor stage	1.423 (0.575-3.517)	0.445

CEA: Carcinoembryonic antigen.