Lee Joo Ho, Chie Eui Kyu, Kim Kyubo, Jeong Seung-Yong, Park Kyu Joo, Park Jae-Gahb, Kang Gyeong Hoon, Han Sae-Won, Oh Do-Youn, Im Seock-Ah, Kim Tae-You, Bang Yung-Jue, Ha Sung W
Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
BMC Cancer. 2013 Dec 5;13:576. doi: 10.1186/1471-2407-13-576.
BACKGROUND: Circumferential resection margin (CRM) and distal resection margin (DRM) have different impact on clinical outcomes after preoperative chemoradiotherapy (CRT) followed by surgery. Effect and adequate length of resection margin as well as impact of treatment response after preoperative CRT was evaluated. METHODS: Total of 403 patients with rectal cancer underwent preoperative CRT followed by total mesorectal excision between January 2004 and December 2010. After applying the criterion of margin less than 0.5 cm for CRM or less than 1 cm for DRM, 151 cases with locally advanced rectal cancer were included as a study cohort. All patients underwent conventionally fractionated radiation with radiation dose over 50 Gy and concurrent chemotherapy with 5-fluorouracil or capecitabine. Postoperative chemotherapy was administered to 142 patients (94.0%). Median follow-up duration was 43.1 months. RESULTS: The 5-year overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS) rates, and locoregional control rates (LRC) were 84.5%, 72.8%, 74.2%, and 86.3%, respectively. CRM of 1.5 mm and DRM of 7 mm were cutting points showing maximal difference in a maximally selected rank method. In univariate analysis, CRM of 1.5 mm was significantly related with worse clinical outcomes, whereas DRM of 7 mm was not. In multivariate analysis, CRM of 1.5 mm, and ypN were prognosticators for all studied endpoints. However, CRM was not a significant prognostic factor for good responders, defined as patients with near total regression or T down-staging, which was found in 16.5% and 40.5% among studied patients, respectively. In contrast, poor responders demonstrated a significant difference according to the CRM status for all studied end-points. CONCLUSIONS: Close CRM, defined as 1.5 mm, was a significant prognosticator, but the impact was only prominent for poor responders in subgroup analysis. Postoperative treatment strategy may be individualized based on this finding. However, findings from this study need to be validated with larger cohort.
背景：环周切缘（CRM）和远侧切缘（DRM）对术前放化疗（CRT）后手术的临床结局有不同影响。评估了切缘的效果和足够长度以及术前CRT后治疗反应的影响。 方法：2004年1月至2010年12月期间，共有403例直肠癌患者接受了术前CRT，随后行全直肠系膜切除术。在应用CRM小于0.5 cm或DRM小于1 cm的标准后，151例局部晚期直肠癌患者被纳入研究队列。所有患者均接受常规分割放疗，放射剂量超过50 Gy，并同时使用5-氟尿嘧啶或卡培他滨进行化疗。142例患者（94.0%）接受了术后化疗。中位随访时间为43.1个月。 结果：5年总生存率（OS）、无病生存率（DFS）、无远处转移生存率（DMFS）和局部区域控制率（LRC）分别为84.5%、72.8%、74.2%和86.3%。1.5 mm的CRM和7 mm的DRM是最大选择秩法中显示最大差异的切点。在单因素分析中，1.5 mm的CRM与较差的临床结局显著相关，而7 mm的DRM则不然。在多因素分析中，1.5 mm的CRM和ypN是所有研究终点的预后因素。然而，CRM对于定义为接近完全缓解或T分期下降的良好反应者不是一个显著的预后因素，在研究患者中分别为16.5%和40.5%。相比之下，对于所有研究终点，不良反应者根据CRM状态显示出显著差异。 结论：定义为1.5 mm的紧密CRM是一个显著的预后因素，但在亚组分析中其影响仅在不良反应者中突出。基于这一发现，术后治疗策略可能需要个体化。然而，本研究的结果需要在更大的队列中进行验证。
Int J Colorectal Dis. 2018-12
J Clin Oncol. 2008-1-10
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