Palmer G, Martling A, Blomqvist L, Cedermark B, Holm T
Department of Surgery, Karolinska University Hospital and Karolinska Institute, SE-171 76 Stockholm, Sweden.
Eur J Surg Oncol. 2005 Sep;31(7):727-34. doi: 10.1016/j.ejso.2005.04.009.
This prospective study reports the results of a multimodality treatment protocol in patients with locally advanced rectal cancer and assesses outcome after curative vs non-curative surgery and in relation to primary advanced vs locally recurrent cancer.
Between 1991 and 2002, 122 patients completed the protocol. Fifty-eight had primary advanced and sixty-four had locally recurrent rectal cancer. Median follow up was 82 months (5-143).
A potentially curative resection was achieved in 59% of the patients with primary advanced and in 34% of patients with locally recurrent cancer. After curative resection, 53 and 59%, respectively, were free from recurrence during the observation time (median 82 months) and the overall 5-year survival was 34 and 40%. Overall 5-year survival in all patients with primary advanced cancer was 29 and 16% in all patients with locally recurrent rectal cancer.
Multimodality treatment may cure at least a third of patients with locally advanced rectal cancer provided a radical resection is performed. As the post-operative morbidity is high, an optimised patient selection for neo-adjuvant treatment and surgery is essential. However, palliative surgery may benefit the patient if local control is achieved. Future studies should focus on the problem of distant metastasis.
本前瞻性研究报告了局部晚期直肠癌患者多模式治疗方案的结果，并评估了根治性手术与非根治性手术后的结局，以及与原发性晚期癌和局部复发性癌的关系。
1991年至2002年间，122例患者完成了该方案。58例为原发性晚期直肠癌，64例为局部复发性直肠癌。中位随访时间为82个月（5 - 143个月）。
原发性晚期癌患者中有59%实现了潜在根治性切除，局部复发性癌患者中有34%实现了潜在根治性切除。根治性切除后，在观察期（中位82个月）内，分别有53%和59%的患者无复发，总体5年生存率分别为34%和40%。原发性晚期癌所有患者的总体5年生存率为29%，局部复发性直肠癌所有患者的总体5年生存率为16%。
如果进行根治性切除，多模式治疗可能治愈至少三分之一的局部晚期直肠癌患者。由于术后发病率高，优化新辅助治疗和手术的患者选择至关重要。然而，如果实现了局部控制，姑息性手术可能使患者受益。未来的研究应关注远处转移问题。
