Objective: To evaluate the treatment strategy, prognosis and pattern of recurrence in patients with rectal cancer.
Methods: From May 1979 to November 2006, 314 patients with recurrence after rectal cancer resection were included in this study. Patients were divided into two groups: local recurrence (LR) and distant metastasis (DM). The clinicopathologic features, treatment strategies and prognosis were analyzed.
Results: Of the 314 patients with recurrence, 168 (53.5%) were LR with a mean recurrence-free interval (RFI) of (24.7+/-1.9) months and 146 (46.5%) were DM with a mean RFI of (22.7+/-1.9) months. Compared to the DM group, the patients in the LR group showed no significant difference in clinicopathological data except the time to recurrence (P<0.01), primary tumor location (P=0.043), and the postoperative use of chemoradiotherapy (P=0.007). Mean recurrence-specific survival(RSS) was (24.7+/-1.9) months for LR and the 3- and 5-year survival rates were 0.48 and 0.25. The 3- and 5-year survival rates in patients with DM were 0.33 and 0.16 with a mean RSS of (22.7+/-1.9) months. The difference was statistically significant (P<0.01). Cox regression analysis for RSS showed that the time to recurrence, TNM stage, and treatment strategy (including procedure and the use of postoperative chemoradiation) were independently prognosis factors for the patients with recurrence rectal cancer (all P<0.01). Subgroup analyses revealed no significant differences in RFI or RSS among different subgroups within either LR or DM groups.
Conclusions: Patients of rectal cancer with LR have a better survival than those with DM. Moreover, radical resection can improve the prognosis of patients with recurrence of rectal cancer, especially for patients with early TNM stage of the primary tumor and later period of recurrence.