Abstract
This retrospective study was undertaken to provide more modern data of real-life management of non-metastatic rectal cancer, to compare therapeutic strategies, and to identify prognostic factors of overall survival (OS) in a large cohort of patients. Data on efficacy and on acute/late toxicity were retrospectively collected. Patients were diagnosed a non-metastatic rectal cancer between 2004 and 2015, and were treated at least with radiotherapy. OS was correlated with patient, tumor and treatment characteristics with univariate and multivariate analyses. Data of 593 consecutive non-metastatic rectal cancer patients were analyzed. Median follow-up was 41 months. Median OS was 9 years. Radiotherapy was delivered in pre-operative (n = 477, 80.5%), post-operative (n = 75, 12.6%) or exclusive (n = 41, 6.9%) setting. In the whole set of patients, age, nutritional condition, tumor stage, tumor differentiation, and surgery independently influenced OS. For patients experiencing surgery, OS was influenced by age, tumor differentiation and nodal status. Surgical resection is the cornerstone treatment for locally-advanced rectal cancer. Poor tumor differentiation and node involvement were identified as major predictive factor of poor OS. The research in treatment intensification and in identification of radioresistance biomarkers should therefore probably be focused on this particular subset of patients.
Highlights
The current standard of care for locally advanced rectal cancer (RC) is a pre-operative chemo-radiation, followed by a total mesorectal excision (TME)
Whereas post-operative chemoradiation is preferred in North America and in other countries, pre-operative chemoradiation is the standard of care in France, based on studies suggesting a better observance, tolerance and local efficacy of preoperative chemoradiation[2,3,11,12]
Therapeutic strategies were systematically discussed in multidisciplinary teams before treatment initiation
Summary
The current standard of care for locally advanced rectal cancer (RC) is a pre-operative chemo-radiation, followed by a total mesorectal excision (TME). Most of the overall survival (OS) prognosis factors were identified with post-operative radiotherapy programs and before TME was systematically performed. This is a major limitation for prognosis factors analysis since publications suggested that the RC modern outcome was much better than it used to be, when trials assessing the benefits of adjuvant therapy were recruiting[7]. The development of staging, surgery, radiotherapy, pathological examination and multidisciplinary teams might have significantly improved the outcome of non-metastatic RC patients. It is of paramount importance to identify current prognosis factors in real-life patients with non-metastatic RC, since such factors. The identification of prognosis factors of overall survival (OS) was retrospectively performed in the whole set of patients, and in the subset of patients undergoing rectal tumor resection
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