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Impact of pre-treatment patient-related selection parameters on outcome in rectal cancer
Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, P9 03, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, P9 03, S-17176 Solna, Sweden..
Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, P9 03, S-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, P9 03, S-17176 Solna, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology. Karolinska Univ Hosp, Karolinska Inst, Dept Oncol Pathol OnkPat K7, Z4 01, S-17176 Stockholm, Sweden.
Karolinska Univ Hosp, Karolinska Inst, Dept Oncol Pathol OnkPat K7, Z4 01, S-17176 Stockholm, Sweden..
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2016 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 42, no 11, 1667-1673 p.Article in journal (Refereed) Published
Abstract [en]

Background: Preoperative radiotherapy (RT) for rectal cancer reduces local recurrence rates and possibly also mortality. Patient-related parameters such as age and comorbidity have a major impact on selection to preoperative RT. The aim of this study was to investigate how this selection influences the outcome in rectal cancer regardless of dose or fractionation of RT.

Methods: Data from the Swedish Colorectal Cancer Registry and the Swedish National Patient Register on all patients without distant metastasis who underwent elective trans-abdominal surgery for rectal cancer 2000-2010 in the Stockholm Gotland region was retrieved. Factors influencing survival and recurrence were identified by Cox regression analyses.

Results: There were 2300 patients included. Among these 70.3% received preoperative RT. Three-year overall survival (OS), disease-free survival (DFS) and local recurrence rate were 80.2, 68.6 and 4.7%, respectively. All outcome measures were significantly improved over time. In a multivariable analysis in patients with comorbidity (Charlson comorbidity index score >= 1), OS were significantly better following preoperative RT than after surgery alone (HR 0.65, 95% CI 0.49-0.87). OS among patients with advanced age (>= 80 years), was not influenced by preoperative RT.

Conclusion: OS among patients with comorbidity was better following preoperative RT than after surgery alone while no differences were seen among the elderly. This indicates that the selection process may be optimised for the patients with advanced age but comorbidity should be used cautiously for exclusion of patients from preoperative RT.

Place, publisher, year, edition, pages
2016. Vol. 42, no 11, 1667-1673 p.
Keyword [en]
Rectal cancer, Survival, Recurrence, Aged, Comorbidity, Radiotherapy
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-309824DOI: 10.1016/j.ejso.2016.05.020ISI: 000387524400008PubMedID: 27318529OAI: oai:DiVA.org:uu-309824DiVA: diva2:1052960
Funder
Swedish Cancer Society
Available from: 2016-12-07 Created: 2016-12-07 Last updated: 2016-12-07Bibliographically approved

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