直肠癌外科决策的多模态术前评估系统：一项随机对照试验。

Multimodal preoperative evaluation system in surgical decision making for rectal cancer: a randomized controlled trial.

机构信息

Anal-Colorectal Surgery, West China Hospital, Sichuan University, 37, Guo Xue Xiang, Chengdu, China.

出版信息

Int J Colorectal Dis. 2010 Mar;25(3):351-8. doi: 10.1007/s00384-009-0839-3.

DOI:10.1007/s00384-009-0839-3

PMID:19921223

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2814035/

Abstract

PURPOSE

Multimodal preoperative evaluation (MPE) is a novel strategy for surgical decision making, incorporating the transrectal ultrasound (TRUS), 64 multi-slice spiral computer tomography (MSCT), and serum amyloid A protein (SAA) for rectal cancer. This trial aims to determine the accuracy of MPE in preoperative staging and its role in surgical decision making for rectal cancer.

METHODS

Two hundred twenty-five participants with histologically proven rectal cancer with tumor height less than 10 cm were randomly assigned into three arms in the ratio 1:1:1. Arm A (MPE) was multimodal staged by the combination of MSCT, TRUS, and SAA. Arm B (MSCT+SAA) was staged by MSCT and SAA. Arm C (MSCT) was staged only by MSCT. The primary endpoints were the accuracy of preoperative staging and expected surgical procedures. This study is registered as an International Standard Randomised Controlled Trial, number ChiCTR-DT-00000409.

RESULTS

The analysis showed statistical difference in the accuracy of T staging between arm A and B (94.6% vs. 77.8%, P=0.003) and arm A and C (94.6% vs. 80.6%, P=0.010). Statistical difference was also observed between the accuracies of preoperative N staging between arm A and C (85.1% vs. 69.4%, P=0.023) and arm A and B (85.1% vs. 84.7%, P=0.029). Surgical decision making in arm A was more accurate than that in arm C (95.9% vs. 80.6%, P=0.001). Pathological T stage (P<0.001), N stage (P<0.001), tumor node metastasis stage (P<0.001), serum level of SAA (P=0.002), and tumor height (P=0.030) were significantly associated with final surgical procedures.

CONCLUSION

MPE is an effective strategy in preoperative staging and more accurate than other available strategies in surgical decision making for rectal cancer.

摘要

目的

多模态术前评估（MPE）是一种新的手术决策策略，用于直肠癌，结合直肠超声（TRUS）、64 层螺旋计算机断层扫描（MSCT）和血清淀粉样蛋白 A 蛋白（SAA）。本试验旨在确定 MPE 在术前分期中的准确性及其在直肠癌手术决策中的作用。

方法

225 名经组织学证实的肿瘤高度小于 10cm 的直肠癌患者被随机分为三组，比例为 1:1:1。A 组（MPE）通过 MSCT、TRUS 和 SAA 联合进行多模态分期。B 组（MSCT+SAA）通过 MSCT 和 SAA 进行分期。C 组（MSCT）仅通过 MSCT 进行分期。主要终点是术前分期和预期手术的准确性。本研究作为国际标准随机对照试验注册，编号 ChiCTR-DT-00000409。

结果

分析显示 T 分期的准确性在 A 组和 B 组（94.6%比 77.8%，P=0.003）和 A 组和 C 组（94.6%比 80.6%，P=0.010）之间存在统计学差异。术前 N 分期的准确性在 A 组和 C 组（85.1%比 69.4%，P=0.023）和 A 组和 B 组（85.1%比 84.7%，P=0.029）之间也存在统计学差异。A 组的手术决策比 C 组更准确（95.9%比 80.6%，P=0.001）。病理 T 分期（P<0.001）、N 分期（P<0.001）、肿瘤淋巴结转移分期（P<0.001）、血清 SAA 水平（P=0.002）和肿瘤高度（P=0.030）与最终手术方式显著相关。