Department of Colorectal Surgery, Cancer Hospital Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, People's Republic of China.
Clin Colorectal Cancer. 2011 Mar 1;10(1):37-41. doi: 10.3816/CCC.2011.n.005.
To explore the long-term outcome and prognostic factors for early stage rectal cancer patients undergoing standard resection (SR) or local excision (LE).
This study included 350 patients with stage I rectal cancer, in which 283 cases (80.9%) received SR, and 67 cases (19.1%) received LE. Survival analyses were performed to compare outcomes of different surgeries.
The 5-year local recurrence (LR) rate was 14.1% in LE group versus 3.3% in SR group (P= .0004), and the 10-year overall survival (OS) rate was not significantly different between the 2 groups. Multivariate analysis suggested that LE was an independent risk factor for 5-year LR rate and 10-year OS rate. Tumor grade was found related to 5-year LR, and T stage was found related to 10-year OS. Tumor size of 2.5 cm is found as a possible cut-off for predicting 5-year LR rate in LE group, with a sensitivity of 77.8% and a specificity of 75.9%. In patients with LE, the 5-year LR rate for tumors ≥ 2.5 cm was 40%, compared with 4.3% for tumors < 2.5 cm (P = .001).
Local excision in early-stage rectal cancer may result in high local recurrence rate. The procedure is only recommended in highly selective groups of patients. A tumor size of 2.5 cm is a useful criterion for choosing LE rather than SR.
探索行标准切除术(SR)或局部切除术(LE)的早期直肠癌患者的长期预后及相关因素。
本研究纳入了 350 例 I 期直肠癌患者,其中 283 例(80.9%)接受了 SR,67 例(19.1%)接受了 LE。生存分析用于比较不同手术的结果。
LE 组的 5 年局部复发(LR)率为 14.1%,而 SR 组为 3.3%(P=.0004),两组 10 年总生存率(OS)无显著差异。多因素分析表明,LE 是 5 年 LR 率和 10 年 OS 率的独立危险因素。肿瘤分级与 5 年 LR 相关,T 分期与 10 年 OS 相关。肿瘤大小 2.5cm 可能是 LE 预测 5 年 LR 率的一个临界点,其敏感性为 77.8%,特异性为 75.9%。在 LE 患者中,肿瘤≥2.5cm 的 5 年 LR 率为 40%,而肿瘤<2.5cm 的 LR 率为 4.3%(P=.001)。
早期直肠癌的局部切除可能导致较高的局部复发率。该手术仅推荐用于高度选择的患者群体。肿瘤大小 2.5cm 是选择 LE 而非 SR 的一个有用标准。