直肠癌综合治疗后肺复发为主：一项原创回顾性研究。

Pulmonary recurrence predominates after combined modality therapy for rectal cancer: an original retrospective study.

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.

出版信息

Ann Surg. 2012 Jul;256(1):111-6. doi: 10.1097/SLA.0b013e31825b3a2b.

DOI:10.1097/SLA.0b013e31825b3a2b

PMID:22664562

Abstract

OBJECTIVE

To characterize patterns of recurrence in locally advanced rectal cancer treated with combined modality therapy (CMT): neoadjuvant chemoradiation + total mesorectal excision + adjuvant chemotherapy.

METHODS

A total of 593 consecutive rectal cancer patients (1998 to 2007) with locally advanced (stage II/III) disease (noted on endorectal ultrasound or magnetic resonance imaging) who received CMT were analyzed for patterns of recurrence.

RESULTS

After median 44-month follow-up (interquartile range, 25 to 64 months), 119 patients (20%) recurred: 105 distant, 7 local, 7 local and distant, and 112 distant-only recurrence. Ninety-three (78%) had single-organ recurrence, and 26 (22%) had multiple-organ recurrence. The most common site of distant recurrence was lung (69% of all patients with distant relapse); 20% had liver recurrence. Fourteen patients (2.4%) recurred locally. Pulmonary metastases were most commonly identified by computed tomographic scan versus abnormal positron emission tomographic (PET) scan or carcinoembryonic antigen (CEA). Risk factors associated with pulmonary recurrence were the following: pathologic stage, tumor distance from anal verge, lymphovascular or perineural invasion. Five-year freedom from pulmonary recurrence for patients with 0, 1, 2, or 3 risk factors was 99%, 90%, 61%, and 42%, respectively. Thirty of 59 patents with pulmonary recurrence underwent lung metastasectomy; 3-year freedom from recurrence was 37%.

CONCLUSIONS

Unlike colon cancer, which most frequently recurs in the liver, locally advanced rectal cancer treated with CMT relapses most frequently in the lung. Pulmonary metastasis was associated with advanced pathologic stage, low-lying tumor, lymphovascular invasion, or perineural invasion. Confirmation of pulmonary metastasis usually requires serial imaging because metastases are often small when initially detected, well below the resolution of PET, and not necessarily associated with elevated CEA. Individualized risk-based surveillance strategies are recommended in this patient population.

摘要

目的

描述接受联合治疗（新辅助放化疗+全直肠系膜切除术+辅助化疗）的局部晚期直肠癌的复发模式：新辅助放化疗+全直肠系膜切除术+辅助化疗。

方法

对 1998 年至 2007 年间接受 CMT 治疗的 593 例局部晚期（Ⅱ/Ⅲ 期）疾病（直肠内超声或磁共振成像显示）的连续直肠癌患者的复发模式进行了分析。

结果

中位随访 44 个月（四分位距 25 至 64 个月）后，119 例（20%）患者复发：105 例远处转移，7 例局部转移，7 例局部和远处转移，112 例远处转移。93 例（78%）患者为单器官复发，26 例（22%）患者为多器官复发。最常见的远处复发部位是肺（所有远处复发患者的 69%）；20%的患者有肝转移。14 例（2.4%）患者局部复发。肺转移最常见的检查是计算机断层扫描，而非异常正电子发射断层扫描（PET）扫描或癌胚抗原（CEA）。与肺转移相关的危险因素如下：病理分期、肿瘤距肛缘距离、血管淋巴管或神经周围侵犯。无 0、1、2、3 个危险因素的患者 5 年肺无复发生存率分别为 99%、90%、61%和 42%。59 例肺转移患者中有 30 例接受了肺转移切除术；3 年无复发率为 37%。

结论

与结肠癌不同，局部晚期直肠癌最常在肝脏复发，而接受 CMT 治疗的局部晚期直肠癌最常在肺部复发。肺转移与晚期病理分期、低位肿瘤、血管淋巴管侵犯或神经周围侵犯有关。肺转移的确认通常需要连续进行影像学检查，因为转移灶最初通常较小，低于 PET 的分辨率，并且不一定与 CEA 升高相关。建议在这一患者群体中采用基于风险的个体化监测策略。