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Peking University Cancer Hospital, China
Title: Which is the most common site of metastasis after curative resection with neoadjuvant radiotherapy for rectal cancer :the liver or the lungs?

Professor Gu Jin is an eminent surgeon and is currently Professor of colorectal Surgery Department of Beijing Cancer Hospital, Peking University Cancer Hospital. He is also Chairman of the Chinese Society of Oncology (Chinese Medical Association). He graduated with a medical degree from Beijing Medical University, after which he went on to complete further training as a Visiting Scholar at Les Hôpitaux Universitaires de Strasbourg, France and then at the Columbia School of Physicians and Surgeons, US. Prior to assuming his present appointment, he held the position of Attending Physician before being promoted to Professor and Deputy Director of the Department of Surgery, Beijing Medical University, China. He has published more than 71 papers in reputed journals.


BACKGROUND: The liver and the lung are generally known as the most common sites of metastasis in rectal cancer. OBJECTIVE: To investigate the incidence, timing and predictive factors of metachronous hepatic and pulmonary metastases after curative resection with neoadjuvant radiotherapy. DESIGN: This study is a retrospective analysis of prospectively collected data. SETTING: This study was conducted at a tertiary referral cancer hospital. PATIENTS: A total of 382 consecutive patients with locally advanced rectal cancer (LARC) who received curative resection with neoadjuvant radiotherapy from 2002 to 2011 were enrolled in this study. MAIN OUTCOME MEASURES: The primary outcomes measured were the incidence and timing of pulmonary and hepatic metastases and associated risk factors. RESULTS: Seventy-six patients with LARC followed by curative resction (19.9%) developed distant metastases. The 5-year disease-free survival for the entire cohort was 77.5%. The most common site of metastases was the lung (57.9%, n=44), followed by liver 38.2% (n=29), bone 18.4% (n=12), extra-regional lymph nodes 9.2% (n=7), peritoneum 7.9% (n=6), and brain 2.6% (n=2). Median interval from rectal surgery to identification of pulmonary metastases was much longer than that of hepatic metastases (20.2 months vs 10.1 months, p=0.022). In multivariate analysis, pulmonary recurrence was significantly associated with pathologic T stage (HR=3.820, 95% CI: 1.444-10.105; P=0.007), and pathologic N stage (HR=3.432, 95% CI: 1.681-7.006; P=0.001). As for liver metastases, only the pathologic T stage (HR = 3.659, 95% CI: 1.395-9.601; p = 0.008) retained its significance in logistic regression multivariate analysis. LIMITATIONS: The study is limited by its retrospective and single institutional nature. In addition, only one third of the metastasis were histologically or cytologically confirmed, the proportion is way lower than other studies CONCLUSION: Our study emphasizes that the lung was the most common site of recurrence in a cohort with LARC who underwent neoadjuvant radiotherapy and curative surgery. As differences in patterns of pulmonary and hepatic metastases are observed, tailor-made and organ-targeted surveillance strategies leading to early detection of metastatic disease is strongly needed.

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