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. 2022 Oct 24;22(1):1088.
doi: 10.1186/s12885-022-10212-3.

The pattern and treatment outcomes for rectal cancer with concurrent locoregional recurrence and distant metastases after total mesorectal excision

Yikuan Chen #  1   2 , Yaqi Li #  1   2 , Shaobo Mo #  1   2 , Xiang Hu  1   2 , Fangqi Liu  1   2 , Sanjun Cai  1   2 , Xiaoji Ma  3   4 , Junjie Peng  5   6
Affiliations

The pattern and treatment outcomes for rectal cancer with concurrent locoregional recurrence and distant metastases after total mesorectal excision

Yikuan Chen et al. BMC Cancer. .

Abstract

Background: To study the pattern and treatment outcome of rectal cancer (RC) with concurrent locoregional recurrence (LR) and distant metastasis (DM) after total mesorectal excision (TME) and to identify patient-, disease-, and treatment-related factors associated with differences in prognosis after concurrent LR and DM.

Methods: RC patients who were diagnosed with concurrent LR and DM after TME from May 2015 to June 2019 were included in our study. All patients received single or multiple treatment modalities under the guidance of multidisciplinary team (MDT) of colorectal cancer in Fudan University Shanghai Cancer Center. The prognostic value of various clinicopathological factors for survival were calculated by Kaplan-Meier curves and Cox regression analyses.

Results: A total of 74 RC patients with concurrent LR and DM who had undergone TME with a median follow-up of 27 months were eligible for analysis. The median survival of the included patients was 34 months, and 30 patients (41%) died. Fifty-nine patients (80%) underwent comprehensive treatments. Patients with oligometastatic disease (OMD) achieved no evidence of disease (NED) status more frequently than those with multiple metastases (P = 0.003). In the univariate analysis, patients achieving NED, diagnosed with OMD and five or less peritoneal metastases tended to have longer survival after LR and DM diagnosis (P < 0.05). In the multivariate analysis, attaining NED status was the only independent factor for survival (hazard ratio (HR), 2.419; P = 0.032). Survival after concurrent LR and DM in the non-NED group was significantly shorter than that in the NED group (median survival, 32 vs. 46 months; HR, 2.7; P = 0.014).

Conclusions: The pattern and treatment outcome of RC with concurrent LR and DM after TME has changed with the development of multiple treatment modalities. Although the prognosis remains poor, pursuing NED status through comprehensive treatments may improve the survival of RC patients with concurrent LR and DM after TME.

Keywords: Distant metastasis; Locoregional recurrence; NED; Rectal cancer; Treatment outcome.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Time of diagnosis of concurrent locoregional recurrence (LR) and distant metastasis (DM) after total mesorectal excision (TME)
Fig. 2
Fig. 2
Overall survival of 74 patients after concurrent locoregional recurrence (LR) and distant metastasis (DM) diagnosis
Fig. 3
Fig. 3
Kaplan–Meier analysis of overall survival in 74 patients after locoregional recurrence (LR) and distant metastasis (DM) according to no evidence of disease (NED) status (A), type of DM (B) and number of peritoneal metastases (C)
See this image and copyright information in PMC

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