Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea.
Dis Colon Rectum. 2012 Oct;55(10):1024-31. doi: 10.1097/DCR.0b013e3182644334.
Little is known about the oncologic outcomes of patients with ypT0 rectal cancer after preoperative chemoradiotherapy.
To evaluate the clinicopathologic characteristics and oncologic outcomes of patients with ypT0 rectal cancer after preoperative chemoradiotherapy and curative radical surgery.
This was a retrospective review of factors influencing outcome of patients treated with preoperative chemoradiotherapy for rectal cancer at a tertiary care university medical center in Seoul, Korea between 2000 and 2008.
A total of 830 rectal cancer patients underwent surgery after preoperative chemoradiotherapy. Patients were included in the study if they had a pretreatment clinical classification of T3-4 or N+ (or T2N0 and preoperative chemoradiotherapy for sphincter preservation) and if they were classified on pathologic examination as ypT0 after preoperative CRT and curative radical surgery. Patients were classified as.
Overall survival and disease-free survival were evaluated in relation to ypT0N0 or ypT0N1-2 status and other factors that might influence outcome.
Of 91 patients included in the study, 54 (59.3%) were men; the mean patient age was 55 (SD, 11) years, and mean follow-up duration was 44 (SD, 23) months. Surgical procedures included low anterior resection in 68 patients, abdominoperineal resection in 21, and intersphincteric resection in 2. Mean tumor distance from the anal verge was 4.7 (SD, 1.8) cm. Of the 91 patients, 85 were classified as ypT0N0 and 6 as ypT0N1-2. No patient experienced local recurrence. A total of 11 patients (12.1%) had distant metastases, after a mean 11.1 months, including 7 (8.2%) with ypT0N0 and 4 (66.7%) with ypT0N1-2 tumors. One patient with ypT0N0 and 2 patients with ypT0N1-2 tumors died of metastasis. In patients classified as ypT0N0, the 5-year disease free survival and overall survival rates were 82.3% and 89.2%, respectively. Multivariate analysis showed that ypN1-2 status (p = 0.001) was a significant independent risk factor for recurrence (decreased 5-year disease-free survival), but no factor was associated with 5-year overall survival.
The study is limited by its retrospective nature.
Oncologic outcomes in patients with ypT0N0 rectal cancer were excellent. The presence of residual cancer cells in mesorectal lymph nodes represents a risk factor for distant metastasis.
术前放化疗后 ypT0 直肠患者的肿瘤学结果知之甚少。
评估术前放化疗和根治性手术治疗后 ypT0 直肠患者的临床病理特征和肿瘤学结果。
这是对韩国首尔一家三级保健大学医学中心 2000 年至 2008 年间接受术前放化疗治疗的直肠患者的结局影响因素的回顾性分析。
共有 830 例直肠患者在术前放化疗后接受手术。如果患者在术前有临床 T3-4 或 N+（或 T2N0 和术前放化疗以保留括约肌）的分类，并且在术前 CRT 和根治性手术后的病理检查中被分类为 ypT0，则将其纳入研究。患者分为。
总体生存和无病生存与 ypT0N0 或 ypT0N1-2 状态及可能影响结局的其他因素有关。
在 91 例纳入研究的患者中，54 例（59.3%）为男性；患者平均年龄为 55 岁（标准差，11 岁），平均随访时间为 44 个月（标准差，23 个月）。手术方式包括低位前切除术 68 例，腹会阴切除术 21 例，肛门内外括约肌间切除术 2 例。肿瘤距肛门缘的平均距离为 4.7 厘米（标准差，1.8 厘米）。91 例患者中，85 例为 ypT0N0，6 例为 ypT0N1-2。无局部复发。平均 11.1 个月后，共有 11 例（12.1%）患者发生远处转移，包括 7 例（8.2%）ypT0N0 和 4 例（66.7%）ypT0N1-2 肿瘤。1 例 ypT0N0 和 2 例 ypT0N1-2 肿瘤患者死于转移。在 ypT0N0 患者中，5 年无病生存率和总生存率分别为 82.3%和 89.2%。多因素分析显示，ypN1-2 状态（p=0.001）是复发（降低 5 年无病生存率）的显著独立危险因素，但没有因素与 5 年总生存率相关。
研究受其回顾性性质的限制。
ypT0N0 直肠患者的肿瘤学结果非常好。中直肠淋巴结中残留癌细胞的存在是远处转移的危险因素。
