Recurrence risk following rectal cancer surgery: a survival analysis of key predictors

Abstract Background Identifying predictors of postsurgical recurrence in patients with rectal cancer is critical for optimizing postoperative management and improving patient outcomes. We aimed to assess the effects of demographic, clinical, and pathological factors on recurrence risk after rectal cancer surgery. Methods We conducted a secondary analysis of data from patients who underwent curative rectal cancer surgery between 2004 and 2018. A Cox proportional hazards regression model was applied to examine the influence of variables on recurrence risk. Kaplan–Meier curves were used to visualize cumulative hazards. Results Among 961 patients (62.7% male, mean age 63.1 years), 127 (13.2%) experienced recurrence over a median follow-up of 60 months. Based on the Cox model (C-index = 0.770, likelihood ratio test χ2(19) = 127.5, P < 0.001), significant predictors of increased recurrence risk included pathologic node stage N1 (hazard ratio 2.92, 95% CI: 1.84–4.63, P < 0.001) and N2 (4.05, 2.36–6.94, P < 0.001), as well as fewer than 12 harvested lymph nodes (1.95, 1.31–2.90, P = 0.001). Moderately differentiated histology reduced recurrence risk (0.49, 0.27–0.89, P = 0.018), and age (0.98, 0.96–0.99, P = 0.004) was inversely correlated with recurrence risk. Sex, chemotherapy, pathologic tumor stage, and lymphovascular invasion were not significant predictors of recurrence. Conclusion This study identified key factors associated with recurrence risk after rectal cancer surgery, highlighting the importance of pathologic node stage, lymph node metrics, and histological differentiation. These findings provide a foundation for personalized postoperative management strategies and improving long-term outcomes in rectal cancer patients.