Development of the ‘PREDICT’ score through a systematic review and meta-analysis of the predictive parameters for locoregional recurrence after total mesorectal excision

Abstract

Background

Despite robust management techniques, locoregional recurrence rates of rectal cancer are still significant. Although offering intensive follow-up has been shown to be beneficial in the early detection, it can be resource consuming. Having a robust knowledge of risk factors of locoregional recurrence will help in identification of patients who actually need intensive follow-up programs. This review aimed to identify the factors that can predict locoregional recurrence after Total mesorectal excision (TME).

Methods

We systematically reviewed PubMed, Scopus and Cochrane for relevant articles with no date restrictions while language was restricted to English. We only included articles that had either provided Hazards ratio (HR)/odds ratio (OR) or provided enough data that allowed calculation of HR/OR specifically for rectal cancer. Articles were deemed eligible if they included patients undergoing (TME).

Results

Seventeen studies (18,605 patients) published between 2002 and 2019 were included. A total of 699 patients developed locoregional recurrence at a median time of 25.2 months after surgery. There were eight significant predictors evaluated by more than one study; T3–T4 stage, circumferential resection margin, lymphovascular invasion, mucinous histology, N1–N2 stage, positive distal resection margin, Tumor < 5 cm from anal verge, and lack of neoadjuvant radiotherapy. A scoring system was developed based on the weight and pooled OR/HR of each predictor.

Conclusion

Using predictive factors identified in our review in context of scoring system may help in the early detection of locoregional recurrence after TME. This may help in tailoring the application of intensive follow-up programs.

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Authors

Contributions

Sualeh Muslim Khan designed the study, searched the literature, extracted the data, interpreted the data, Wrote the first draft. Sameh Hany Emile, Searched literature, assessed the quality of studies, analyzed the data and critically revised the manuscript. Samer Hani Barsoum, contributed to data analysis interpretation, critically revising the manuscript and final approval of article. Syed Osama Ahsan. Extracted the data, assessed the quality of studies and contributed to data interpretation. All mentioned authors gave permission for final approval of manuscript for submission.

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Correspondence to Sualeh Muslim Khan.

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Khan, S.M., Emile, S.H., Barsom, S.H. et al. Development of the ‘PREDICT’ score through a systematic review and meta-analysis of the predictive parameters for locoregional recurrence after total mesorectal excision. Updates Surg 73, 35–46 (2021). https://doi.org/10.1007/s13304-020-00853-z

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Keywords

  • Rectal cancer
  • Predictive factors
  • Locoregional recurrence