Published online Apr 15, 2021. doi: 10.4251/wjgo.v13.i4.252
Peer-review started: September 10, 2020
First decision: November 3, 2020
Revised: January 11, 2021
Accepted: March 16, 2021
Article in press: March 16, 2021
Published online: April 15, 2021
Distant relapse has become the leading cause of cancer death in locally advanced rectal cancer. The standard treatment of locally advanced rectal cancer, neoadjuvant chemoradiation (NACRT) followed by surgery, inevitably delays delivery of systemic treatment.
This study investigated prognostic factors for distant metastasis, especially early distant metastasis, using the standard treatment paradigm to identify the most effective treatments according to recurrence risk.
We investigated prognostic factors for early distant metastasis, using the standard treatment paradigm to identify the most effective neoadjuvant treatments according to recurrence risk.
The authors retrieved data from 148 consecutive rectal cancer patients from January 2015 through December 2019 who underwent NACRT for having clinical T 3-4 or clinical N 1-2 disease according to the 8th American Joint Committee on Cancer staging system.
Patients with early distant metastasis were more likely to have poorly differentiated tumor (P = 0.025), tumors with involved mesorectal fascia (P = 0.002), and extramural venous invasion (P = 0.012) than those who did not. Due to the small number of patients who received magnetic resonance imaging and inherent limitation of retrospective study, prospective studies with large number of patients are needed.
For patients with risk factors for early distant metastasis, early systemic chemotherapy could be beneficial. According to the risk factors, neoadjuvant treatment should be individualized.
Future studies that include carefully applied imaging and randomized design are required.