病理性淋巴结分类是术前放化疗和根治性切除治疗的直肠癌患者无病生存的最具鉴别力的预后因素。

Pathologic nodal classification is the most discriminating prognostic factor for disease-free survival in rectal cancer patients treated with preoperative chemoradiotherapy and curative resection.

机构信息

Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

出版信息

Int J Radiat Oncol Biol Phys. 2010 Jul 15;77(4):1158-65. doi: 10.1016/j.ijrobp.2009.06.019. Epub 2009 Sep 30.

DOI:10.1016/j.ijrobp.2009.06.019

PMID:19800178

Abstract

PURPOSE

We retrospectively evaluated the effects of clinical and pathologic factors on disease-free survival (DFS) with the aim of identifying the most discriminating factor predicting DFS in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection.

METHODS AND MATERIALS

The study involved 420 patients who underwent preoperative CRT and curative resection between August 2001 and October 2006. Gender, age, distance from the anal verge, histologic type, histologic grade, pretreatment carcinoembryonic antigen (CEA) level, cT, cN, cStage, circumferential resection margin, type of surgery, preoperative chemotherapy, adjuvant chemotherapy, ypT, ypN, ypStage, and tumor regression grade (TRG) were analyzed to identify prognostic factors associated with DFS. To compare the discriminatory prognostic ability of four tumor response-related pathologic factors (ypT, ypN, ypStage, and TRG), the Akaike information criteria were calculated.

RESULTS

The 5-year DFS rate was 75.4%. On univariate analysis, distance from the anal verge, histologic type, histologic grade, pretreatment CEA level, cT, circumferential resection margin, type of surgery, preoperative chemotherapeutic regimen, ypT, ypN, ypStage, and TRG were significantly associated with DFS. Multivariate analysis showed that the four parameters ypT, ypN, ypStage, and TRG were, consistently, significant prognostic factors for DFS. The ypN showed the lowest Akaike information criteria value for DFS, followed by ypStage, ypT, and TRG, in that order.

CONCLUSION

In our study, ypT, ypN, ypStage, and TRG were important prognostic factors for DFS, and ypN was the most discriminating factor.

摘要

目的

我们回顾性评估了临床和病理因素对无病生存（DFS）的影响，旨在确定在接受术前放化疗（CRT）和根治性切除的直肠癌患者中，预测DFS 的最具鉴别力的因素。

方法和材料

这项研究纳入了 420 例于 2001 年 8 月至 2006 年 10 月期间接受术前 CRT 和根治性切除的患者。分析了性别、年龄、距肛缘距离、组织学类型、组织学分级、术前癌胚抗原（CEA）水平、cT、cN、c 期、环周切缘、手术类型、术前化疗、辅助化疗、ypT、ypN、yp 期、肿瘤消退分级（TRG），以确定与 DFS 相关的预后因素。为了比较与肿瘤反应相关的四个病理因素（ypT、ypN、yp 期和 TRG）的鉴别预后能力，计算了 Akaike 信息准则。

结果

5 年 DFS 率为 75.4%。单因素分析显示，距肛缘距离、组织学类型、组织学分级、术前 CEA 水平、cT、环周切缘、手术类型、术前化疗方案、ypT、ypN、yp 期和 TRG 与 DFS 显著相关。多因素分析显示，ypT、ypN、yp 期和 TRG 是 DFS 的一致显著预后因素。ypN 对 DFS 的 Akaike 信息准则值最低，其次是 yp 期、ypT 和 TRG。