Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):856-62. doi: 10.1016/j.ijrobp.2010.10.079. Epub 2011 Feb 6.
To investigate, in a comparative analysis, the prognostic implications of postchemoradiotherapy (post-CRT) pathologic stage (ypStage) vs. postoperative pathologic stage (pStage) in rectal cancer.
Between May 2001 and December 2006, 487 patients with T3 mid or distal rectal cancer were analyzed retrospectively. Concurrent CRT was administered preoperatively (n = 364, 74.7%) or postoperatively (n = 123, 25.3%). The radiation dose was 50.4 Gy in 28 fractions. All patients underwent a total mesorectal excision and received adjuvant chemotherapy. Disease-free survival (DFS) was estimated using the Kaplan-Meier method. Differences in DFS, stratified by ypStage and pStage, were compared using the log-rank test.
For surviving patients, the median follow-up period was 68 months (range, 12-105 months). The 5-year local recurrence-free survival rate was not different, at 95.3% and 92.1% in preoperative and postoperative CRT groups, respectively (p = 0.402), but the 5-year distant metastasis-free survival rate was significantly different, at 81.6% (preoperative CRT) vs. 65.4% (postoperative CRT; p = 0.001). The 5-year DFS rate of 78.8% in the preoperative CRT group was significantly better than the 63.0% rate in the postoperative CRT group (p = 0.002). Post-CRT pathologic Stage 0-I occurred in 42.6% (155 of 364) of the patients with preoperative CRT. The 5-year DFS rates were 90.2% (ypStage 0-I), 83.5% (ypStage II), 77.3% (pStage II), 58.6% (ypStage III), and 54.7% (pStage III). The DFS rate of ypStage 0-I was significantly better than that of ypStage II or pStage II. Post-CRT pathologic Stage II and III had similar DFS, compared with pStage II and III, respectively.
Disease-free survival predicted by each ypStage was similar to that predicted by the respective pStage. Improved DFS with preoperative vs. postoperative CRT was associated with the ypStage 0-I group that showed a similarly favorable outcome to pStage I rectal cancer.
在对比分析中研究直肠癌放化疗后（ypStage）病理分期与术后病理分期（pStage）的预后意义。
2001 年 5 月至 2006 年 12 月，回顾性分析了 487 例 T3 中下段直肠癌患者。术前（n=364，74.7%）或术后（n=123，25.3%）给予同期放化疗。放疗剂量为 50.4 Gy/28 次。所有患者均行全直肠系膜切除术，并接受辅助化疗。采用 Kaplan-Meier 法估计无病生存（DFS）。采用对数秩检验比较 ypStage 和 pStage 分层的 DFS 差异。
对于存活患者，中位随访时间为 68 个月（12-105 个月）。术前 CRT 组和术后 CRT 组的 5 年局部无复发生存率分别为 95.3%和 92.1%（p=0.402），但 5 年远处无复发生存率差异有统计学意义，分别为 81.6%（术前 CRT）和 65.4%（术后 CRT；p=0.001）。术前 CRT 组的 5 年 DFS 率为 78.8%，显著优于术后 CRT 组的 63.0%（p=0.002）。42.6%（155 例）术前 CRT 患者的 post-CRT 病理分期为 0-Ⅰ期。ypStage 0-Ⅰ、ypStage Ⅱ、ypStage Ⅱ、pStage Ⅱ、ypStage Ⅲ和 pStage Ⅲ的 5 年 DFS 率分别为 90.2%、83.5%、77.3%、58.6%和 54.7%。ypStage 0-Ⅰ的 DFS 率显著优于 ypStage Ⅱ或 pStage Ⅱ。与 pStage Ⅱ和Ⅲ相比，post-CRT 病理分期Ⅱ和Ⅲ的 DFS 相似。
各 ypStage 预测的无病生存率与相应的 pStage 预测的无病生存率相似。与术后 CRT 相比，术前 CRT 改善的 DFS 与 ypStage 0-I 组相关，该组的结局与 pStage I 直肠癌相似。
