Background: Despite therapeutic advances, recurrence continues to undermine outcomes in locally advanced rectal cancer. Identifying clinicopathologic factors linked to recurrence and survival may support tailored follow-up strategies and improve patient care.
Methods: We retrospectively analyzed 339 patients with locally advanced rectal cancer who underwent curative surgery followed by either neoadjuvant (NCRT) or adjuvant chemoradiotherapy (ACRT). Clinicopathologic data included age, sex, tumor differentiation, clinical stage, and treatment modality. Disease-free survival (DFS) was estimated with Kaplan–Meier methods, group differences were assessed with the log-rank test, and Cox regression was applied to identify predictors of DFS.
Results: The cohort included 146 women and 193 men, with a median age of 59 years and median follow-up of 38 months. Tumor differentiation was predominantly well (77.9%), with 10.0% moderate, 2.4% poor, and 9.7% unknown. Clinical stage was localized in 173 (51.0%) and regional in 136 (40.1%) patients. NCRT was administered to 162 (47.8%) and ACRT to 177 (52.2%). Overall, 16.2% (n=55) experienced recurrence, of which 56.4% were local and 43.6% distant. Female patients had higher recurrence than males (21.2% vs. 12.4%, p<0.05). No associations were observed between recurrence and differentiation, stage, treatment type, or age group (all p>0.05). The median recurrence time was 13.4 months, and 83.6% of recurrence patients subsequently died. DFS rates at one, three, and five years were 59%, 14%, and 9% among recurrence cases, compared with 83%, 66%, and 60% in non-recurrence patients (p<0.001). Cox regression confirmed recurrence as an independent predictor of poor survival (HR 4.20, 95% CI 2.94–6.00, p<0.001).
Conclusion: Recurrence remains a pivotal determinant of survival in locally advanced rectal cancer. Female patients were more prone to recurrence, while other clinicopathologic features showed no significant associations. These findings underscore the need for vigilant surveillance and suggest further research into sex-related biological mechanisms driving recurrence.
