Risk factors for long-term survival in patients with ypN+ M0 rectal cancer after radical anterior resection.

ABSTRACT

BACKGROUND: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection. METHODS: 112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model. RESULTS: In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR 3.11, 95% CI 1.01-9.56, p = 0.047), presence of perineural invasion (HR 7.27, 95% CI 2.74-19.3, p < 0.001) and occurrence of postoperative complications (HR 6.79, 95% CI 2.09-22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR 0.33, 95% CI 0.12-0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR 4.275, 95% CI 1.44-12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR 0.22, 95% CI 0.082-0.586, p = 0.002). CONCLUSIONS: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.