Prognostic Value of Pathological Risk Parameters in Predicting Postrecurrent Survival for Locally Recurrent Rectal Cancer Patients Undergoing Salvage Radical Surgery: Result from a Median 5-year Follow-Up Study.

Abstract

Salvage surgery represents a potentially curative option for patients with locally recurrent rectal cancer (LRRC); however, heterogeneity in postoperative outcomes remains poorly characterized. This study aimed to determine whether pathological characteristics of the primary tumor, combined with anatomical recurrence patterns, could stratify survival following salvage surgery. We conducted a retrospective analysis of 199 patients with LRRC who underwent salvage radical resection at a single high-volume institution. Primary tumor pathological risk parameters (PRPs)-including tumor deposits, lymphovascular invasion, and perineural invasion-were evaluated for their association with postrecurrence survival (PRS). A three-tier classification system, termed pathology-anatomy risk stratification (PARS), integrating PRPs and recurrence patterns, was developed and assessed for its prognostic value regarding PRS and local re-recurrence-free survival (LrRFS). Among the 199 included patients, the median PRS was 63.7 months. The presence of PRPs in the primary tumor was significantly associated with noncentral recurrence patterns (P = 0.022) and reduced PRS. The PARS classification demonstrated significant stepwise stratification of both PRS and LrRFS (P < 0.001 for both). Patients classified as PARS type III ( ≥ 2 PRPs with noncentral recurrence) had the poorest outcomes. Integration of primary tumor pathological features and recurrence patterns can effectively stratify postoperative outcomes in patients with LRRC undergoing salvage surgery. The PARS classification system may provide a practical tool for risk stratification and personalized postoperative management.