Experience of 1446 rectal cancer patients in Korea and analysis of prognostic factors

• Published in: International journal of colorectal disease Vol. 14; no. 2; pp. 101 - 106
• Main Authors: PARK, Y. J, YOUK, E. G, CHOI, H. S, HAN, S. U, PARK, K. J, LEE, K. U, CHOE, K. J, PARK, J.-G
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.04.1999; Berlin Springer Nature B.V
• Subjects: Adult; Biological and medical sciences; Cancer; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Korea - epidemiology; Lymphatic system; Male; Medical prognosis; Medical sciences; Metastasis; Middle Aged; Multivariate Analysis; Prognosis; Rectal Neoplasms - epidemiology; Rectal Neoplasms - mortality; Rectal Neoplasms - surgery; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Survival Rate; Tropical medicine; Tumors; Asia; Korea; Human; Rectal disease; Carcinoma; Prognosis; Indication; Malignant tumor; Epidemiology; Survival; Clinical stage; Treatment; Rectum; Digestive diseases; Intestinal disease; Diagnosis; Predictive factor; Public health
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s003840050193

In order to investigate the changing pattern of rectal cancers in Korea and to identify prognostic factors, we investigated the case histories of 1446 rectal cancer patients who had received surgical treatment. During the study period there were trends toward a decrease in the ratio of rectal cancer to colon cancer, earlier detection (more Dukes' stages A and B and fewer C), a decrease in the number of abdominoperineal resections, and an increase in the number of sphincter-preserving operations. Univariate analysis of prognostic factors showed that gender, obstruction symptoms, preoperative serum carcinoembryonic antigen (CEA) level, tumor size, depth of bowel wall invasion, lymph node metastases (presence and number), tumor differentiation, operative method, and date of operation were significant, but age, symptom duration, and tumor location were not. The use of sphincter-saving operations did not adversely affect the clinical outcome. Multivariate analysis showed lymph node metastasis factor to be the most significant factor (P < 0.001); the depth of bowel wall invasion, differentiation, CEA level, and date of operation were also significant (0.001 < P < 0.05). This study shows that although anatomical extent of disease (depth of invasion and lymph node metastasis) is the most reliable prognostic predictor in rectal cancer, other factors such as preoperative CEA level and tumor differentiation also provide important information on the outcome and use of an anal-preserving operation does not adversely affect the patient survival.