TITLE:
Clinical Predictors for Reduced Long-Term Survival and Cause of Death after Curative Resection for Rectal Cancer
AUTHORS:
Ola Røkke, Thomas Heggelund, Jūratė Šaltytė Benth, Marianne Steffensen Røkke, Kjell Øvrebø
KEYWORDS:
Rectal Cancer, Predictors, Survival, Recurrence, Reoperation, Complication, Cause of Death
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.12 No.1,
January
19,
2021
ABSTRACT: Purpose: To identify clinical predictors for reduced long-term survival and describe the cause of death after surgical
treatment for rectal cancer. Methods: A retrospective follow-up study of 442
consecutive, unselected patients treated for rectal cancer at a tertiary
centre from 1990 until 2000 and followed for 17 years or until death. Predictors for death were assessed by Cox
regression analysis. The cause of death was obtained from the Norwegian
Cause of Death Registry. Results: 254 men and 188 women with a median
age of 71 years (21 - 95 years) were resected for rectal cancer with low
anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s
procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5
years (0 - 17 years). The relative five-year survival rates for stages I, II,
III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of
deaths due to recurrence from colorectal cancer in stages I, II, III and IV was
23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular
disease and other malignancies were the cause of death in the other patients.
Higher age, abdominoperineal resection
compared to low anterior resection, lack of lymph node dissection
compared to total mesorectal excision (TME), postoperative reoperations, TNM
stages II and III compared to stage I and residual tumours after surgery were
all significant independent predictors of reduced survival in the adjusted Cox
regression model. Conclusions: Age, tumour
stage, type of surgery, lymph node dissection, residual tumour after surgery and reoperations are predictors for survival after surgery for rectal
cancer. In the patients who died, the cause of death was due to a condition
other than colorectal cancer recurrence in 32.3% of the patients. The five-year
relative survival rate was related to tumour stage.