Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH 44195, USA.
J Gastrointest Surg. 2011 Mar;15(3):444-50. doi: 10.1007/s11605-010-1197-8. Epub 2010 Dec 8.
The aim of this study was to determine the effect of a longer interval between neoadjuvant chemoradiation and surgery on perioperative morbidity and oncologic outcomes.
A colorectal cancer database was queried for clinical stage II and III rectal cancer patients undergoing neoadjuvant chemoradiation followed by proctectomy between 1997 and 2007. The neoadjuvant regimen consisted of long course external beam radiation and 5-fluorouracil chemotherapy. Patients with inflammatory bowel disease, hereditary cancer, extracolonic malignancy, urgent surgery, or non-validated treatment dates were excluded. Patients were divided into two groups according to the interval between chemoradiation and surgery (<8 and ≥ 8 weeks). Perioperative complications and oncologic outcomes were compared.
One hundred seventy-seven patients were included. Groups were comparable with respect to demographics, tumor, and treatment characteristics. Perioperative complications were not affected by the interval between chemoradiation and surgery. Patients undergoing surgery ≥ 8 weeks after chemoradiation experienced a significant improvement in pathologic complete response rate (30.8% vs. 16.5%, p = 0.03) and had decreased 3-year local recurrence rate (1.2% vs. 10.5%, p = 0.04). A Cox regression analysis was performed to assess the compounding effect of a complete pathologic response on oncologic outcome. A longer interval correlated with less local recurrence, although statistical significance was not reached (p = 0.07).
An interval between chemoradiation and surgery ≥ 8 weeks is safe and is associated with a higher rate of pathologic complete response and decreased local recurrence.
本研究旨在确定新辅助放化疗与手术之间间隔时间的延长对围手术期发病率和肿瘤学结果的影响。
通过查询 1997 年至 2007 年间接受新辅助放化疗后行直肠切除术的临床 II 期和 III 期直肠癌患者的结直肠癌数据库，来进行本研究。新辅助方案包括长程外照射和氟尿嘧啶化疗。排除炎症性肠病、遗传性癌症、结外恶性肿瘤、紧急手术或未经证实的治疗日期的患者。根据放化疗与手术之间的间隔时间（<8 周和≥8 周），将患者分为两组。比较围手术期并发症和肿瘤学结果。
本研究共纳入 177 例患者。两组在人口统计学、肿瘤和治疗特征方面具有可比性。放化疗与手术之间的间隔时间不会影响围手术期并发症。在放化疗后≥8 周接受手术的患者，病理完全缓解率显著提高（30.8%比 16.5%，p=0.03），3 年局部复发率降低（1.2%比 10.5%，p=0.04）。进行 Cox 回归分析以评估病理完全缓解对肿瘤学结果的复合影响。更长的间隔时间与较低的局部复发率相关，但未达到统计学意义（p=0.07）。
放化疗与手术之间的间隔时间≥8 周是安全的，并且与更高的病理完全缓解率和降低的局部复发率相关。
