Retrospective Analysis Of Recurrence After Radical Resection Of Rectal Cancer

Objective:to investigate the relationship between the site of recurrence and metastasis of rectal cancer and the location of primary tumor,the influencing factors of postoperative recurrence free survival time(RFS)and the effect of postoperative adjuvant chemotherapy on RFS.So as to provide evidence for further follow-up and precise treatment of rectal cancer patients after operation.Methods:the medical records of 115 patients who underwent radical rectal cancer surgery from July 2012 to December 2015 in the first affiliated Hospital of Guangxi Medical University were collected.The clinical and pathological features of the patients(including sex,age,anemia,preoperative albumin level,preoperative CEA,leakage,surgical approach,tumor location,tumor size,percentage of tumor to intestinal cavity,overall shape of tumor,degree of differentiation,Pathological type of tumor,T stage,N stage,TNM stage,number of total lymph node dissection and lymph node fraction(%),presence or absence of cancer nodules,vessel and nerve invasion),the details of adjuvant therapy(including adjuvant chemotherapy,start time of adjuvant chemotherapy,continuous cycle of adjuvant chemotherapy,adjuvant chemotherapy regimen,etc.),the location of the first recurrence and metastasis,and the specific time of recurrence and metastasis were recorded.The location and time of the first recurrence and metastasis were determined according to the patient's medical record information,examination report and follow-up data according to the electronic medical record data as the main way of follow-up.The last follow-up date was December 30,2018.Follow-up period of at least three years.The obtained data by SPSS22.0 software of data for statistical analysis.recurrence and metastasis as the end point,survival analysis by Kaplan-meier method,single factor analysis by log rank test,and multi-factor analysis by Cox regression model.A chi-square test was used to compare the rates.Finally,the relationship between the site of recurrence and metastasis and the location of primary tumor,the risk factors of postoperative RFS and the effect of postoperative adjuvant chemotherapy on RFS were analyzed.Results:in this study,115 patients developed postoperative recurrence and metastasis.There were 81 cases of distant metastasis,42 cases of local recurrence and 8 cases of distant metastasis combined with local recurrence.The median RFS was 17 months in patients with distant metastasis,12 months in liver metastasis and 20 months in lung metastasis.The median of RFS in patients with local recurrence was 15 months.There was significant difference in local recurrence rate between above and below peritoneal reentrances(p=0.040),but there was no significant difference in liver metastasis rate and lung metastasis rate between the two groups.After radical resection of rectal cancer,the time range of RFS was 3 to 49months,the median of RFS was 17 months.The recurrence and metastasis within 12 months after radical resection of rectal cancer(41/115),within 24months(87/115)and within 3 years(87/115)respectively,The peak time of recurrence was 11 months and 12 months after operation.Univariate analysis showed that the grade of differentiation,pathological type,T-stage,N-stage,TNM-stage,LNR(%),presence or absence of cancer nodules,vessel and nervous system invasion and anastomotic fistula were correlated with postoperative RFS(p<0.05);Multivariate analysis showed that cancer nodules(rr:1.800ci:1.085-2.984p=0.023),vascularnerveinvasion(rr:1.662ci:1.118-2.472 p=0.012)and N-stage(rr:1.727 ci:1.351-2.209 p<0.001)were independent risk factors for RFS after radical resection of rectal cancer.Without postoperative adjuvant chemotherapy and less than 4 cycles of chemotherapy were defined as incomplete postoperative adjuvant chemotherapy.In this study,adjuvant chemotherapy was recommended in 102 patients with???stage.of whom 53 patients completed adjuvant chemotherapy and 49patients did not complete postoperative adjuvant chemotherapy.The median RFS of the two groups were 19 months and 12 months,respectively,there was statistical difference between the two groups(p=0.004).The beginning time of adjuvant chemotherapy was less than 4 weeks group and more than 4 weeks group median RFS(20 months vs12 months,p<0.035),there was significant difference between the two groups.There was no significant difference between different adjuvant chemotherapy regimens(xelox group,sox group,folfox group,xeloda monotherapy group)(?~2=1.542,p=0.673).Conclusion:1.The lower rectum is prone to local recurrence.There is no difference in the incidence of liver metastasis and lung metastasis among the different sites of primary rectal tumors;2.The presence or absence of tumor nodules,vascular nerve invasion and N-stage were independent risk factors for RFS after radical resection of rectal cancer;3.Continuous completion of at least4 cycles of adjuvant chemotherapy after operation,and early initiation of adjuvant chemotherapy can prolong RFS.