Lino-Silva Leonardo Saúl, Molina-Frías Ernesto, Salcedo-Hernández Rosa Angélica, Herrera-Gómez Angel, Padilla-Rosciano Alejandro
Departamento de Patología Oncológica Gastrointestinal, Instituto Nacional de Cancerología, México DF, México.
Acta Gastroenterol Latinoam. 2013 Sep;43(3):198-205.
The most important prognostic factors influencing survival of patients with rectal carcinoma (RC) are lymph node metastases and mesorectal excision (ME). The adequate pathologic examination (APE) of rectal specimens is a standardized pathologic work-up that differs of the conventional colonic/intestinal pathologic work-up. The aim of this study was to determine the impact of APE on staging, lymph node retrieval and survival, with the hypotheses that APE allows high lymph node retrieval and better survival.
We retrospectively analyzed patient with surgery for RC from 2004 to 2011. We described the APE of radical rectal resection and we compared the clinical and pathological characteristics and the oncologic results, including survival after and before APE.
A total of 185 patients were evaluated, 114 constituted the pre-APE group and 71 the APE group. The mean lymph node retrieval was 13.7 in the pre-APE group and 19.6 in the APE group (P = 0.007). In the APE group we found less local recurrence (20% vs 34%, P = 0.024), more lymph-vascular invasion (20% vs 5%, P = 0.003), higher prevalence of high grade tumors (20% vs 4%, P = 0.001), more alive patients free of disease (75% vs 49%, P = 0.001), more frequent use of neoadjuvant therapy (58% vs 31%, P = 0.001), and and better 4-year survival (78% vs 53%, P = 0.044). CONCLU- SION: The APE is crucial in patients with RC for staging and planning further treatment. An APE added to neoadjuvant or adjuvant therapy was associated with better survival.
影响直肠癌（RC）患者生存的最重要预后因素是淋巴结转移和直肠系膜切除（ME）。直肠标本的充分病理检查（APE）是一种标准化的病理检查方法，与传统的结肠/肠道病理检查不同。本研究的目的是确定APE对分期、淋巴结获取和生存的影响，并假设APE能实现高淋巴结获取率和更好的生存。
我们回顾性分析了2004年至2011年接受RC手术的患者。我们描述了根治性直肠切除的APE，并比较了临床和病理特征以及肿瘤学结果，包括APE前后的生存情况。
共评估了185例患者，其中114例组成APE前组，71例组成APE组。APE前组的平均淋巴结获取数为13.7个，APE组为19.6个（P = 0.007）。在APE组中，我们发现局部复发较少（20%对34%，P = 0.024），淋巴血管侵犯较多（20%对5%，P = 0.003），高级别肿瘤的患病率较高（20%对4%，P = 0.001），无病存活患者较多（75%对49%，P = 0.001），新辅助治疗的使用更频繁（58%对31%，P = 0.001），4年生存率更高（78%对53%，P = 0.044）。结论：APE对RC患者的分期和进一步治疗规划至关重要。在新辅助或辅助治疗中增加APE与更好的生存相关。
