STAGE-I RECTAL-CANCER - IDENTIFICATION OF HIGH-RISK PATIENTS

Background: Stage I rectal cancer (T1, T2 N0) is currently treated by surgical resection alone. Despite adequate surgical resection, approxi mately 10-15% of patients mill develop recurrence. Identification of p atients at high risk for recurrence could potentially lead to an impro vement in outcome by selection of these patients for adjuvant therapy. Methods: Between June 1986 and September 1996, 211 patients with prim ary rectal cancer (stage I) were treated by radical surgical resection alone. The medical data of all patients were entered into a database and prospectively followed. The following 10 prognostic factors were c orrelated with recurrence and tumor-related mortality: patient factors : age, gender, and preoperative carcinoembryonic antigen level; tumor factors: location from the anal verge (< 6 cm vs. greater than or equa l to 6 cm), T stage (T1 vs. T2), intratumoral blood vessel invasion (B VI), intratumoral lymphatic vessel invasion, presence of tumor ulcerat ion, and histologic differentiation; and treatment-related factors: ex tent of surgical resection-abdominal perineal resection versus low ant erior resection. Univariate analysis of the effect of the prognostic f actors on recurrence and tumor-related mortality were performed by the method of Kaplan-Meier and log rank test. Independent prognostic fact ors were determined by a multivariate analysis performed using the Cox proportional hazards model. Results: The overall 5-year actuarial rec urrence was 12% and tumor-related mortality was 10%. Independent predi ctors of recurrence were male gender and BVI. Independent predictors o f tumor-related mortality were male gender, BVI, and poorly differenti ated tumors. Conclusions: Despite radical resection, patients with sta ge I rectal cancer with male gender, BVI, and poorly differentiated tu mors should be considered high-risk patients. (C) 1998 by the American College of Surgeons.