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The Link Between Local Recurrence and Distant Metastases in Patients With Rectal Cancer

Background/Aim: The relationships between local recurrence (LR), the development of distant metastases (DM) and prognosis in patients with rectal cancer remain unclear. Patients and Methods: In 606 patients who underwent curative resection, the role of LR was assessed retrospectively by time-dependent multivariate Cox models with inverse probability of treatment weighting taking into account competing risks. Results: Patients with LR had more DM than patients without LR (49/79, 62% vs. 86/524, 16.4%; p<0.001); 37% of LR-associated DM developed before or at LR, 63% after diagnosis of LR. Fifty-five percent of patients without DM at diagnosis of LR later developed DM. In these patients, the incidence of DM significantly exceeded the incidence in patients without LR. DM risk was most strongly associated with preceding LR and stage UICC III and II. Conclusion: There is a causal link between LR and DM in patients with rectal cancer.