Fujita Shin, Yamamoto Seiichiro, Akasu Takayuki, Moriya Yoshihiro
Department of Surgery, National Cancer Center Hospital, 1-1 Tukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan.
Int J Colorectal Dis. 2008 Nov;23(11):1073-9. doi: 10.1007/s00384-008-0513-1. Epub 2008 Jul 2.
To clarify the indications for preoperative adjuvant radiotherapy for rectal cancer, the outcome of patients who underwent curative surgery without adjuvant radiotherapy was investigated.
A total of 817 consecutive patients who underwent curative surgery for clinical stage II or III rectal cancer without preoperative adjuvant radiotherapy between 1988 and 2002 were reviewed.
The actuarial 5-year local recurrence rate in the examined patients was 6.2%. Univariate analysis showed that sex, pathological T classification (pT), clinical N classification (cN), pathological N classification (pN), tumor site, distance from the anal verge, type of surgery, pathological stage, a positive radical margin, lymphatic invasion, and venous invasion were significantly correlated with local recurrence. Multivariate analysis of preoperative factors identified cN, distance from the anal verge, and sex as statistically significant risk factors for local recurrence. In patients with rectal cancer located less than 5 cm from the anal verge and with positive cN, the local recurrence rate was more than 10%.
Patients with rectal cancer located less than 5 cm from the anal verge and with clinically positive lymph nodes should be given preoperative adjuvant radiotherapy.
为明确直肠癌术前辅助放疗的适应证，对未接受辅助放疗而行根治性手术的患者的结局进行了调查。
回顾了1988年至2002年间连续817例未接受术前辅助放疗而行临床II期或III期直肠癌根治性手术的患者。
所检查患者的精算5年局部复发率为6.2%。单因素分析显示，性别、病理T分期（pT）、临床N分期（cN）、病理N分期（pN）、肿瘤部位、距肛缘距离、手术类型、病理分期、切缘阳性、淋巴管浸润和静脉浸润与局部复发显著相关。术前因素的多因素分析确定cN、距肛缘距离和性别为局部复发的统计学显著危险因素。对于距肛缘小于5 cm且cN阳性的直肠癌患者，局部复发率超过10%。
距肛缘小于5 cm且临床淋巴结阳性的直肠癌患者应接受术前辅助放疗。
