Suárez J, Vera R, Balén E, Gómez M, Arias F, Lera J M, Herrera J, Zazpe C
Department of General Surgery, Hospital de Navarra, Pampalona, Spain.
Colorectal Dis. 2008 Jul;10(6):563-8. doi: 10.1111/j.1463-1318.2007.01424.x. Epub 2007 Dec 7.
The reduction in tumour stage induced by full course radiotherapy plus chemotherapy is apparent from histological changes. The purpose of this study was to determine the rate of complete pathological response and to evaluate the prognostic value for disease free survival (DFS) and disease specific survival (DSS) of the response. The relation between pretreatment variables (age, gender, stage, tumour height and [carcinoembryogenic antigen (CEA)] and postsurgical variables was compared to the pathological response.
A total of 119 patients with stage II or III rectal cancer underwent surgery 6 weeks after neoadjuvant treatment. Group A included patients with a complete or good pathological response (Mandard grade I-II) and group B patients with a poor response (Mandard grade III-IV-V). The pretreatment endo-rectal ultrasound scan stage was compared with histopathology stage of the resected specimen. DFS and DSS were compared using the log-rank test.
All 119 patients (mean age 67.9 years, 83 males) underwent resection. The tumour was located in the upper, middle and lower third of the rectum in 11, 51 and 57 patients. 88 patients had a low anterior resection, 28 patients abdomino-perineal resection and three a Hartmann's operation. There was no postoperative death. The circumferential margin (CM) was involved in 10%. A complete pathological response was observed in 17 (14.2%) patients. Thirty-six (30.2%) patients had a group A and 83 a group B response. Group A showed DFS to be significantly higher than group B (log rank: P = 0.007). The DSS rate was not significantly different between the two groups (log rank P = 0.113). Down-staging was not related with DFS. No relation was found between pretreatment variables and response. A good pathological response was related to a lower rate of permanent colostomy but not with CM involvement or the number of lymph nodes.
Tumour regression of grades I or II was a good indicator of DFS in locally advanced rectal cancer, treated by neoadjuvant chemotherapy and radiotherapy. Patients with a high regression grade were associated with a lower incidence of definitive stoma formation. The regression grade was shown to be a better prognostic factor than down-staging.
全疗程放疗联合化疗所诱导的肿瘤分期降低可从组织学改变中明显看出。本研究的目的是确定完全病理缓解率，并评估该缓解对无病生存期（DFS）和疾病特异性生存期（DSS）的预后价值。将术前变量（年龄、性别、分期、肿瘤高度和癌胚抗原（CEA））与术后变量之间的关系与病理缓解情况进行比较。
119例II期或III期直肠癌患者在新辅助治疗6周后接受手术。A组包括病理缓解完全或良好（Mandard分级I-II级）的患者，B组包括缓解较差（Mandard分级III-IV-V级）的患者。将术前直肠内超声扫描分期与切除标本的组织病理学分期进行比较。使用对数秩检验比较DFS和DSS。
119例患者（平均年龄67.9岁，男性83例）均接受了手术。肿瘤位于直肠上、中、下三分之一的患者分别为11例、51例和57例。88例患者行低位前切除术，28例患者行腹会阴切除术，3例患者行Hartmann手术。无术后死亡病例。环周切缘（CM）受累率为10%。17例（14.2%）患者观察到完全病理缓解。36例（30.2%）患者为A组反应，83例为B组反应。A组的DFS显著高于B组（对数秩检验：P = 0.007）。两组的DSS率无显著差异（对数秩检验P = 0.113）。分期降低与DFS无关。术前变量与缓解之间未发现相关性。良好的病理缓解与永久性结肠造口率较低相关，但与CM受累情况或淋巴结数量无关。
I级或II级肿瘤消退是新辅助化疗和放疗治疗局部晚期直肠癌DFS的良好指标。消退分级高的患者确定性造口形成的发生率较低。消退分级被证明是比分期降低更好的预后因素。
