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Open Access 09-06-2024 | Rectal Cancer | Global Health Services Research

Risk Factors for Recurrence After Surgery for Rectal Cancer in a Modern, Nationwide Population-Based Cohort

Authors: Sepehr Doroudian, MD, Erik Osterman, MD, PhD, Bengt Glimelius, MD, PhD

Published in: Annals of Surgical Oncology

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Abstract

Background

The success of modern multimodal treatment in rectal cancer is dependent on risk prediction. Better knowledge of the risk of locoregional and distant recurrence, in relation to preoperative treatment, pathological stage, and commonly used risk factors, is needed when deciding on adjuvant therapy and surveillance.

Methods

The Swedish ColoRectal Cancer Registry was used to identify patients diagnosed with rectal adenocarcinoma between 2011 and 2018. Readily available variables, including patient, tumor, and treatment factors were exposures. Cox proportional hazard models were used to identify important risk factors for recurrence and calculate recurrence risks.

Results

A total of 9428 curatively resected patients were included and followed for a median of 72 months. Eighteen percent had distal recurrence and 3% had locoregional recurrence at 5 years. Risk factors with major impact on distal recurrence were pT4a (hazard ratio [HR] 5.1, 95% confidence interval [CI] 3.3–8.0), pN2b (HR 3.4, 95% CI 2.7–4.2), tumor deposit (HR 1.7, 95% CI 1.5–1.9), lymph node yield (HR 1.5, 95% CI 1.3–1.8), and tumor level 0–5 cm (HR 1.5, 95% CI 1.3–1.8). Pathologic stage and number of risk factors identified groups with markedly different recurrence risks in all neoadjuvant treatment groups.

Conclusions

Readily available risk factors, as a complement to stage, are still valid and robust in all neoadjuvant treatment groups. Tumor deposit is important, while circumferential resection margin might no longer be important with improved oncological treatments and high-quality TME surgery. Tailored surveillance is possible in selected groups using risk stratification based on stage and risk factors.
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Metadata
Title
Risk Factors for Recurrence After Surgery for Rectal Cancer in a Modern, Nationwide Population-Based Cohort
Authors
Sepehr Doroudian, MD
Erik Osterman, MD, PhD
Bengt Glimelius, MD, PhD
Publication date
09-06-2024
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15552-x
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