Department of Colorectal Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2011 Dec;18(13):3666-72. doi: 10.1245/s10434-011-1788-y. Epub 2011 May 18.
Neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy is typically recommended for patients with locally advanced rectal cancer. Patients with pathologically node-negative tumors have an improved prognosis, but recurrence patterns and independent prognostic factors in these patients have been incompletely characterized.
Using a retrospective cohort study design, we included all rectal cancer patients treated with neoadjuvant chemoradiation and curative surgery from 1993 through 2003, who had ypN0 tumors. We characterized recurrence rates and patterns in patients not treated with adjuvant chemotherapy. Secondarily, we compared them to patients who did receive adjuvant treatment and assessed for independent prognostic factors, using univariate and multivariable survival analyses.
Overall, 324 ypN0 patients (ypT0: n = 73; ypT1-2: n = 130; ypT3-4: n = 120) were followed for a median of 5.8 years. The risk of recurrence was associated with pathologic stage-2.7% ypT0, 12.3% ypT1-2, 24.2%ypT3-4. Five-year recurrence-free survival in patients who did not receive adjuvant treatment was 100% (ypT0), 84.4% (ypT1-2) and 75% (ypT3-4). There was no significant difference in 5-year recurrence-free survival between patients who did and did not receive adjuvant treatment. In multivariable analysis, pathologic stage was the factor most strongly associated with recurrence (hazard ratio 3.6 for ypT3-4 vs. ypT0-2, 95% confidence interval 1.9-6.7, P < 0.0001).
The recurrence rates for selected patients with ypT0-2N0 rectal cancer after neoadjuvant chemoradiation and total mesorectal excision are low. Although standard practice remains completion of planned postoperative adjuvant chemotherapy for all patients undergoing chemoradiation, these data suggest prospective trials may be warranted to measure the benefit of adjuvant chemotherapy in favorable subgroups, such as ypT0-2N0.
新辅助放化疗后手术和辅助化疗通常适用于局部晚期直肠癌患者。病理淋巴结阴性肿瘤患者预后较好，但这些患者的复发模式和独立预后因素尚未完全描述。
采用回顾性队列研究设计，纳入 1993 年至 2003 年间接受新辅助放化疗和根治性手术治疗且ypN0 肿瘤的所有直肠癌患者。我们描述了未接受辅助化疗的患者的复发率和模式。其次，将其与接受辅助治疗的患者进行比较，并使用单变量和多变量生存分析评估独立的预后因素。
总体而言，324 例 ypN0 患者（ypT0：n = 73；ypT1-2：n = 130；ypT3-4：n = 120）中位随访 5.8 年。复发风险与病理分期相关-ypT0 为 2.7%，ypT1-2 为 12.3%，ypT3-4 为 24.2%。未接受辅助治疗的患者 5 年无复发生存率为 100%（ypT0）、84.4%（ypT1-2）和 75%（ypT3-4）。接受和未接受辅助治疗的患者 5 年无复发生存率无显著差异。多变量分析显示，病理分期是与复发最密切相关的因素（ypT3-4 与 ypT0-2 相比，风险比 3.6，95%置信区间 1.9-6.7，P < 0.0001）。
新辅助放化疗和全直肠系膜切除术后，ypT0-2N0 直肠癌患者的复发率较低。尽管标准治疗仍然是对所有接受放化疗的患者完成计划的术后辅助化疗，但这些数据表明，可能需要进行前瞻性试验来衡量辅助化疗在 ypT0-2N0 等有利亚组中的获益。
