Analysis Of Prognostic Factors In Rectal Cancer

Purpose:To investigate the clinicopathologic characteristics and prognostic factors of rectal cancer.Methods:A total of 905 rectal cancer patients diagnosed in the First Affiliated Hospital of Medical College of Zhejiang University from Jan.2001 to Jun.2005 were followed up,and 428 cases that were finally diagnosed by pathology and with complete follow-up data entered the study,univariate and multivariate analysis were performed by SPSS,and postoperative chemotherapy,the total number of lymph nodes and lymph node ratio were further analyzed.Results:Univariate analysis shows that gross tumor configuration,histological type,depth of penetration(T),lymph node involvement(N),distant metastasis (M),Dukes staging,the preoperative serum level of CEA(carcinoembryonic antigen ) and CA199 are factors related to the outcome.But patients'gender,age,duration of symptom,location and size of tumor,type of operation and anastomotic leak are the factors which have no significant effect on prognosis.Multivariate analysis shows that the depth of penetration(T),lymph node involvement(N),distant metastasis (M) and the preoperative CEA level are independent prognostic factors.The total number of lymph nodes examined have significant effect on prognosis for patients at Dukes B and Dukes A+B stage,but not for Dukes A.Lymph node ratio have significant effect on prognosis not only for the whole group,but also for Dukes C stage.Patients at Dukes C stage,postoperative chemotherapy can increase its 3-year overall survival obviously.Conclusions:T,N,M staging are the most significant independent prognostic factors for rectal cancer,the preoperative CEA level may be an appropriate modification to the present pathologic staging system.The lymph node ratio and the total number of lymph nodes are also significant prognostic factors.Postoperative chemotherapy is an important adjuvant therapy for rectal cancer at Dukes C after surgery.