Treatment and subsequent prognosis in locally recurrent rectal cancer: a multicenter retrospective study of 498 patients

Abstract

Purpose

Locally recurrent rectal cancer (LRRC) has a tremendous impact on prognosis as well as the quality of life. Because of the low incidence and various recurrence patterns, the treatment outcome of LRRC is not fully elucidated. The current study aimed to evaluate the prognosis and identify the prognosticators in patients with LRRC.

Methods

We conducted a multicenter study at 24 hospitals in Japan. Patients with primary rectal cancer who underwent curative resection between 1997 and 2012 and developed local recurrence only as a first recurrent event were recruited. The primary outcome of our study was overall survival (OS) after a diagnosis of LRRC.

Results

Four hundred and ninety-eight patients were included in the study. Of these, 213 (42.8%) underwent surgical resection; this was associated with the best 5-year OS rate of 52%, followed by carbon ion/proton therapy (44%). Among LRRC patients, undifferentiated type, T4, high CEA level, and high CA19–9 level were independent prognosticators of OS (hazard ratio (HR) = 1.83, P = 0.008, HR = 1.54, P = 0.004, HR = 1.35, P = 0.03, and HR = 1.58, P = 0.003, respectively).

Conclusions

This large-scale cohort study showed that surgical resection led to a favorable prognosis compared to other treatments for LRRC. Therefore, surgical resection should be considered whenever feasible for LRRC patients. In addition, undifferentiated type, T4, and tumor marker (CEA and CA19–9) elevation were identified as independent prognostic factors for OS among patients with LRRC.

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Acknowledgements

The data of this study was acquired from 24 hospitals, participating in the Japanese Study Group for Postoperative Follow-up of CRC. We appreciate the representatives of each hospital: I. Takemasa (Sapporo Medical University); K. Hakamada (Hirosaki University); H. Kameyama (Niigata University); Y. Takii (Niigata Cancer Center Hospital); H. Ueno (National Defense Medical College); H. Ozawa (Tochigi Cancer Center); S. Ishihara (Tokyo University); K. Takahashi (Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital); Y. Kanemitsu (National Cancer Center Hospital); M Itabashi (Tokyo Women’s Medical University); T. Kiyomatsu (National Center for Global Health and Medicine); Y Kinugasa (Tokyo Medical and Dental University); K. Okabayashi (Keio University); Y. Hashiguchi (Teikyo University); T. Masaki (Kyorin University); M. Watanabe (Kitasato University); A. Shiomi (Shizuoka Cancer Center); T. Hanai (Fujita Health University); K. Komori (Aichi Cancer Center Hospital); Y. Sakai (Kyoto University); M. Ohue (Osaka International Cancer Institute); S. Noura (Osaka Rosai Hospital); N. Tomita (Hyogo College of Medicine); and Y. Akagi (Kurume University).

Data availability

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable

Funding

The Japanese Study Group for Postoperative Follow-up of Colorectal Cancer financially supported this work.

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Contributions

TM was involved in study concept and design, acquisition of data, analysis, and interpretation of data, drafting of the manuscript. SY, TM, AK, MT, and KS were involved in the acquisition of data, analysis, and interpretation of data and critical revision of the manuscript for important intellectual content. YK was involved in study concept and design, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, and study supervision.

Corresponding author

Correspondence to Takatoshi Matsuyama.

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Ethics approval and consent to participate

The study was approved by the Central Institutional Review Board (Tokyo Medical and Dental University No. M2017–268). Informed consent was obtained from all participants included in the study.

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Additional informed consent was obtained from all participants whose identifying information is included in this article.

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All authors declare no competing interests.

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Supplementary information

ESM 1
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Supplementary Fig. S1: (a) Cumulative local recurrence incidence from primary rectal cancer surgery. (b) Kaplan–Meier curve showing disease-specific survival according to the type of treatment for local recurrence of rectal cancer in 498 patients (PNG 402 kb)

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Matsuyama, T., Yamauchi, S., Masuda, T. et al. Treatment and subsequent prognosis in locally recurrent rectal cancer: a multicenter retrospective study of 498 patients. Int J Colorectal Dis (2021). https://doi.org/10.1007/s00384-021-03856-3

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Keywords

  • Rectal cancer
  • Local recurrence
  • Over-all survival
  • Prognosis