Distinct Prognosis of High Versus Mid/Low Rectal Cancer: a Propensity Score–Matched Cohort Study
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Rectal cancers have long been treated as a single-entity disease; however, whether the prognosis of high rectal cancer (inferior margin located 10.1 to 15.0 cm from the anal verge) differs from that of mid/low rectal cancer (0 to 10.0 cm) remains disputed.
Patients with stages I–III rectal adenocarcinomas undergoing curative-intent surgery were enrolled between 2007 and 2013 in this retrospective analysis. Exclusion criteria were neoadjuvant therapy or concurrent cancers. Propensity score matching and Cox regression analysis were performed to compare a 5-year overall and cancer-specific survival between patients with high and mid/low rectal cancer.
Of 613 patients who met the inclusion criteria, 199 (32.5%) and 414 (67.5%) had high and mid/low rectal cancer, respectively. After propensity score matching (187 cases for each group), the high group showed a better overall survival (70.9 vs. 56.9%, p = 0.042) and cancer-specific survival (77.4 vs. 60.3%, p = 0.028) at 5 years compared with the mid/low group with stage III disease. However, high rectal cancer did not demonstrate prognostic superiority in stages I–II disease. Multivariate analysis identified high tumor location as an independent prognostic factor for cancer-specific survival (hazards ratio = 0.422, 95% confidence interval 0.226–0.786, p = 0.007) and overall survival (hazards ratio = 0.613, 95% confidence interval 0.379–0.991, p = 0.046).
Patients with stage III high rectal adenocarcinoma demonstrated better overall and cancer-specific survival than those with mid/low type, and tumor location was an independent prognostic factor for patients with rectal carcinomas.
KeywordsHigh rectal cancer Mid/low rectal cancer Propensity score matching Survival
The authors appreciate all the support from the staff of the Division of Gastrointestinal Surgery Center, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. We also thank Prof. Jonathan B. Mitchem of University of Missouri Hospitals and Clinics, Columbia, MO 65212, USA, for linguistic assistance during the preparation of this manuscript.
Conception of the work: Chuang-Qi Chen, Lv-Jia Cheng, and Jian-Hui Chen.
Data acquisition: Lv-Jia Cheng, Song-Yao Chen, Long Yu, Shao-Pu Han, and Zhe-Wei Wei.
Data analysis and interpretation: Lv-Jia Cheng, Jian-Hui Chen, and Chuang-Qi Chen.
Manuscript drafting: Lv-Jia Cheng and Jian-Hui Chen.
Critical revision of manuscript: Chuang-Qi Chen, Zi-Hao Wu, and Yu-Long He.
Final approval: All authors.
Supported by the Science and Technology Planning Project of Guangdong Province (no. 2010B080701106 and no. 2013B021800131) and the Science and Technology Planning Project of Guangzhou City (no. 201604020003).
Compliance with Ethical Standards
An ethical subcommittee of the First Affiliated Hospital of Sun Yat-sen University approved this retrospective study. Written consent was obtained from the patients for their information to be stored in the hospital database and used for research.
Conflict of Interest
The authors declare that they have no competing interests.
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