Retrospective long-term results and prognostic factors of postoperative treatment for UICC stages II and III rectal cancer

Aims. To retrospectively evaluate 5-year local control, disease-free survival, cancer- specific survival and overall survival rates in patients with UICC stages II and III rec- tal cancer treated with adjuvant therapy and especially to analyze the impact of some prognostic factors on clinical outcome at univariate and multivariate analyses. Methods and materials. We retrospectively reviewed 306 patients treated with post- operative 5-fluorouracil-based chemoradiation (278 patients) or radiotherapy alone (28 patients) after curative surgery. The following prognostic factors were considered at univariate and multivariate analyses: age, sex, tumor location, surgery procedure, pathological stage, histology, tumor grade, surgical margins and radiotherapy tech- nique. Results. The 5-year actuarial rates for local control, disease-free survival, cancer-spe- cific survival and overall survival were respectively 89.7%, 59.7%, 68.6% and 61.4% for the 278 patients (91%) treated with postoperative chemoradiation. Univariate analy- sis showed that abdominal-perineal resection impacted disease-free survival and that the T4 variable had an impact on cancer-specific survival and disease-free survival. Instead, age ≥70, N2, IIIB (p T3 p N1) and IIIC (p T3 p N2) stage impacted cancer-spe- cific survival, disease-free survival and rate of distant metastases. Multivariate analy- sis showed as significant variables age ≥70 years, pN1 and pN2 and extraperitoneal tumor location. Conclusions. Our retrospective study showed a good 5-year local control. Factors such as individual pT4, pN1, pN2, age ≥70 years, abdominal-perineal resection, stages IIIB-IIIC versus II-IIIA and extraperitoneal tumor location negatively influ- enced disease-free survival, distant metastases and cancer-specific survival. Differ- ences exist between stages II and III rectal cancer and treatment modulation and in- tensification are required in order to offer the most appropriate and effective adju- vant treatment and to improve survival of rectal cancer patients.