Huh Jung Wook, Lee Woo Yong, Park Yoon Ah, Cho Yong Beom, Yun Seong Hyeon, Kim Hee Cheol, Chun Ho-Kyung
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, Korea.
J Cancer Res Clin Oncol. 2014 Jul;140(7):1221-7. doi: 10.1007/s00432-014-1657-8. Epub 2014 Apr 6.
Prognostic significance of intraoperative staging by surgeons and its possible complementary role with the pathological stage for evaluating the prognosis of rectal cancer after preoperative chemoradiation (CRT) is unknown. The goal of this study is to evaluate the diagnostic accuracy and prognostic role of intraoperative surgical staging by surgeons in patients with rectal cancer after preoperative CRT.
A total of 267 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from December 2007 to March 2010 were retrospectively reviewed. Surgical staging was evaluated by determining its diagnostic accuracy and analyzing its prognostic significance.
Sensitivity, specificity, positive predictive value, and negative predictive value of intraoperative diagnosis of good responders (ypT0-2) were 78, 67, 53, and 86 %, respectively. The overall accuracy of good responders by surgeons was 71 %. A multivariate analysis revealed that pretreatment N stage and maximal tumor diameter were independent predictors for accordance of surgical and pathological diagnoses in T staging. The 3-year disease-free survival rates of the patients with surgical T0, T1, T2, T3, and T4 were 100, 94, 85, 84, and 58 %, respectively, and 86, 81, and 67 % for patients with surgical N0, N1, and N2 disease, respectively (P < 0.001 and P = 0.022, respectively). On multivariate analysis, surgical T stage was an independent prognostic factor for both disease-free survival and local recurrence.
Intraoperative surgical tumor staging by surgeons may be an important predictor of survival in patients with rectal cancer after preoperative CRT.
外科医生进行的术中分期对直肠癌术前放化疗（CRT）后预后的意义及其与病理分期在评估预后方面可能存在的互补作用尚不清楚。本研究旨在评估外科医生对术前CRT后的直肠癌患者进行术中手术分期的诊断准确性和预后作用。
回顾性分析2007年12月至2010年3月期间连续接受术前CRT和根治性切除术的267例直肠癌患者。通过确定手术分期的诊断准确性并分析其预后意义来进行评估。
术中诊断为良好反应者（ypT0-2）的敏感性、特异性、阳性预测值和阴性预测值分别为78%、67%、53%和86%。外科医生对良好反应者的总体准确率为71%。多因素分析显示，治疗前N分期和肿瘤最大直径是T分期中手术与病理诊断一致性的独立预测因素。手术T0、T1、T2、T3和T4患者的3年无病生存率分别为100%、94%、85%、84%和58%，手术N0、N1和N2患者分别为86%、81%和67%（P分别<0.001和P = 0.）。多因素分析显示，手术T分期是无病生存和局部复发的独立预后因素。
外科医生进行的术中手术肿瘤分期可能是直肠癌术前CRT后患者生存的重要预测指标。
