Baik Seung Hyuk, Kim Nam Kyu, Lee Young Chan, Kim Hoguen, Lee Kang Young, Sohn Seung Kook, Cho Chang Hwan
Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea.
Ann Surg Oncol. 2007 Feb;14(2):462-9. doi: 10.1245/s10434-006-9171-0. Epub 2006 Nov 10.
This study was designed to evaluate the prognostic value of circumferential resection margin (CRM) in rectal cancer patients who underwent curative resection with adjuvant chemoradiotherapy (CRT).
We studied 504 patients who underwent total mesorectal excision with adjuvant CRT for rectal cancer between 1997 and 2001. The patients were divided into two groups: a negative CRM group (CRM > 1 mm) and a positive CRM group (CRM <or= 1 mm). The survival rates, local recurrence rates, and systemic recurrence rates were compared between groups.
The negative CRM group had 460 patients and the positive CRM group had 44 patients. The 5-year local and systemic recurrence rates were 11.3 and 25.3%, respectively, in the negative CRM group and 35.2 and 60.8% in the positive CRM group, respectively. The cancer-specific 5-year survival rates for the two groups were 72.5 and 26.9% (P < .001), respectively. CRM was found to be an independent prognostic factor by multivariate analyses which were adjusted for known outcome predictors (P < .001).
Oncological outcome for patients in the positive CRM group is less favorable than for those in the negative CRM group. Adjuvant CRT is not a definite treatment modality that can be used to compensate for a positive CRM following TME and adjuvant CRT in patients with TNM stage II or III rectal cancer.
本研究旨在评估接受辅助放化疗（CRT）的根治性切除直肠癌患者环周切缘（CRM）的预后价值。
我们研究了1997年至2001年间接受直肠癌全直肠系膜切除术及辅助CRT的504例患者。患者分为两组：CRM阴性组（CRM>1mm）和CRM阳性组（CRM≤1mm）。比较两组的生存率、局部复发率和全身复发率。
CRM阴性组有460例患者，CRM阳性组有44例患者。CRM阴性组5年局部和全身复发率分别为11.3%和25.3%，CRM阳性组分别为35.2%和60.8%。两组的癌症特异性5年生存率分别为72.5%和26.9%（P<.001）。通过对已知预后预测因素进行校正的多因素分析发现CRM是一个独立的预后因素（P<.001）。
CRM阳性组患者的肿瘤学结局不如CRM阴性组患者。辅助CRT并非一种确定的治疗方式，不能用于弥补TNM II期或III期直肠癌患者在全直肠系膜切除术和辅助CRT后CRM阳性的情况。
