# Prognostic factors affecting survival and recurrence in patients undergoing curative surgery for rectal cancer: a 10-year retrospective cohort study from a regional tertiary center in Türkiye

## TL;DR

This study identifies key factors that affect survival and recurrence in rectal cancer patients after surgery, based on a 10-year analysis from a Turkish hospital.

## Contribution

The study provides region-specific prognostic factors for rectal cancer outcomes in a Turkish tertiary care setting.

## Key findings

- LVI, PNI, and poor tumor differentiation were strongly linked to higher mortality risk.
- Mid-rectal tumors and advanced T/N stages were associated with increased recurrence.
- Follow-up metastasis and elevated CEA levels predicted poor survival outcomes.

## Abstract

Rectal cancer remains a major health burden worldwide, with significant morbidity and mortality despite advances in multimodal treatment. Identifying factors associated with postoperative mortality and recurrence is crucial for improving long-term outcomes.

To evaluate clinical, pathological, and treatment-related predictors of overall survival (OS) and disease-free survival (DFS) in patients who underwent curative surgery for rectal cancer at a regional tertiary care center in Türkiye.

This retrospective cohort study included 122 patients who underwent rectal cancer surgery between 2013 and 2023 at Van Training and Research Hospital. Demographic, clinical, and pathological variables were recorded, including tumor location, differentiation, lymphovascular invasion (LVI), perineural invasion (PNI), neoadjuvant/adjuvant therapy, and resection margin status. Survival analysis was performed using the Kaplan–Meier method, and independent prognostic factors were identified through multivariate Cox regression.

The median overall survival was 156.0 months (95% CI, 132.4–179.6), and the median disease-free survival was 28.5 months (95% CI, 22.0–36.5). Mortality was significantly associated with LVI (p=0.001), PNI (p=0.007), poor differentiation (p<0.001), R1 resection (p=0.013), emergency surgery (p=0.043), and follow-up metastasis (p<0.001). Patients with LVI had a 3.89-fold increased mortality risk, while follow-up metastasis increased mortality risk 8.75-fold. Recurrence was significantly associated with mid-rectal tumors, advanced T/N stage, LVI, PNI, and positive margins. Elevated carcinoembryonic antigen (CEA) levels were also predictive of poor outcomes.

LVI, PNI, tumor grade, margin status, and follow-up metastasis are strong predictors of recurrence and mortality in rectal cancer surgery. Incorporating these parameters into postoperative risk stratification may enhance surveillance and therapeutic strategies, especially in regional healthcare settings.