Shoup Margo, Guillem Jose G, Alektiar Kaled M, Liau Kathy, Paty Philip B, Cohen Alfred M, Wong W Douglas, Minsky Bruce D
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Dis Colon Rectum. 2002 May;45(5):585-92. doi: 10.1007/s10350-004-6250-9.
This study was designed to determine predictors of survival after surgery and intraoperative radiotherapy for recurrent rectal cancer.
From a prospective database, 634 patients undergoing resection for recurrent rectal cancer between January 1990 and June 2000 were identified. Of these, 111 received intraoperative radiotherapy with curative intent, and 100 were available for follow-up. Clinicopathologic variables from both the primary and recurrent operations were evaluated as predictors of disease-free and disease-specific survival by multivariate Cox regression and log-rank test.
There were 54 males and 46 females, with a median age of 57 (range, 37-83) years. With a median follow-up of 23.2 months, 60 patients (60 percent) recurred: 20 (33 percent) locally, 27 (45 percent) distantly, and 13 (22 percent) at both sites. Of all variables analyzed, only complete resection with microscopically negative margins and the absence of vascular invasion in the recurrent specimen predicted improved disease-free and disease-specific survival (P < 0.01 for all). Median disease-free survival and median disease-specific survival were 31.2 and 66.1 months, respectively, for complete resection compared with 7.9 and 22.8 months for resection with microscopic or grossly positive margins (P < 0.01 for both). Median disease-free survival and median disease-specific survival were 6.4 and 16.1 months, respectively, in the presence of vascular invasion in the recurrent specimen compared with 23.3 and 57.3 months in the absence of vascular invasion (P < 0.01 and P < 0.05, respectively). Complete resection and the absence of vascular invasion were the only predictors of improved local control as well (P < 0.05 and P < 0.01, respectively).
Resection with negative microscopic margins and absence of vascular invasion are independent predictors of local control and improved survival after resection and intraoperative radiotherapy for recurrent rectal cancer.
本研究旨在确定复发性直肠癌手术及术中放疗后生存的预测因素。
从一个前瞻性数据库中，识别出1990年1月至2000年6月期间634例行复发性直肠癌切除术的患者。其中，111例接受了根治性术中放疗，100例可供随访。通过多因素Cox回归和对数秩检验，评估初次手术和复发性手术的临床病理变量作为无病生存和疾病特异性生存的预测因素。
男性54例，女性46例，中位年龄57岁（范围37 - 83岁）。中位随访23.2个月，60例患者（60%）复发：20例（33%）局部复发，27例（45%）远处复发，13例（22%）两处均复发。在所有分析的变量中，只有切缘显微镜下阴性的完整切除以及复发性标本中无血管侵犯可预测无病生存和疾病特异性生存的改善（所有P < 0.01）。切缘显微镜下阴性的完整切除患者的中位无病生存和中位疾病特异性生存分别为31.2个月和66.1个月，而切缘显微镜下或肉眼阳性切除患者的分别为7.9个月和22.8个月（两者P < 0.01）。复发性标本中有血管侵犯患者的中位无病生存和中位疾病特异性生存分别为6.4个月和16.1个月，无血管侵犯患者的分别为23.3个月和57.3个月（分别为P < 0.01和P < 0.05）。完整切除和无血管侵犯也是局部控制改善的唯一预测因素（分别为P < 0.05和P < 0.01）。
切缘显微镜下阴性切除和无血管侵犯是复发性直肠癌切除及术中放疗后局部控制和生存改善的独立预测因素。
