Staudacher Carlo, Di Palo Saverio, Tamburini Andrea Marco, Vignali Andrea, Orsenigo Elena
Dipartimento Assistenziale di Scienze Chirurgiche, Università Vita-Salute S. Raffaele, Milano.
Ann Ital Chir. 2007 Nov-Dec;78(6):493-8.
To evaluate oncological and surgical outcome of patients submitted to neoadjuvant therapy for advanced rectal cancer.
One hundred thirty eight patients (86 male, 52 female, mean age 61.4 years), with tumour of lower (58; 42%), middle (66; 48%), upper rectum (14; 10%), showing a clinical stage II (23; 17%) or III (115; 83%) and with an average distance from anal verge of 6.5 cm, submitted to fractionated "long-course" RT with CT locally staged by US and MR before and after neoadjuvant therapy and operated on after 4-6 weeks by its end.
Surgical procedures (71 of which laparoscopic) were: 114 AR (83.8%), 19 APR (14%) and 3 TEM (2.2%). Mean nodal-sampling was 14.9. A complete or partial response was observed in 48.5% of the patients (67/138). With a mean follow-up of 30 months, local recurrence rate was 5.7%. Five-years overall survival and disease-fee-survival were respectively 73% and 60%.
We observed a significant clinical (p < 0.004) and pathological (p < 0.005) downstaging. Pre-treatment clinical stage was not significant. On the contrary, postoperative yTNM was significant for yT (p < 0.001) and yN (p < 0.0003). Non-responder patients had worse prognosis (5-years survival 30%). The variable with higher prognostic significance was yN (p < 0.0003), especially if we distinguish N1 by N2 (p < 0.0004).
The response to neoadjuvant therapy represents a significant prognostic variable.
评估接受新辅助治疗的晚期直肠癌患者的肿瘤学和手术结局。
138例患者（男性86例，女性52例，平均年龄61.4岁），肿瘤位于直肠下段（58例；42%）、中段（66例；48%）、上段（14例；10%），临床分期为II期（23例；17%）或III期（115例；83%），距肛缘平均距离为6.5 cm，在新辅助治疗前后接受经超声和磁共振局部分期的“长程”分割放疗，并在放疗结束后4 - 6周进行手术。
手术方式（其中71例为腹腔镜手术）包括：114例腹会阴联合直肠癌根治术（AR，83.8%）、19例腹直肠癌根治术（APR，14%）和3例经肛门内镜显微手术（TEM，2.2%）。平均淋巴结采样数为14.9个。48.5%的患者（67/138）观察到完全或部分缓解。平均随访30个月，局部复发率为5.7%。5年总生存率和无病生存率分别为73%和60%。
我们观察到显著的临床（p < 0.004）和病理（p < 0.005）降期。治疗前临床分期无显著意义。相反，术后yTNM分期中yT（p < 0.001）和yN（p < 0.0003）具有显著意义。无反应患者预后较差（5年生存率30%）。预后意义较高的变量是yN（p < 0.0003），尤其是区分N1和N2时（p < 0.0004）。
对新辅助治疗的反应是一个重要的预后变量。
