Department of Colorectal Surgery, Singleton Hospital, Swansea, UK.
Br J Surg. 2014 Sep;101(10):1290-8. doi: 10.1002/bjs.9570. Epub 2014 Jun 12.
This study compared outcomes after surgery alone for stage II/ III rectal cancer in a tertiary cancer unit versus highly selective use of preoperative chemoradiotherapy (CRT).
This was a single-centre retrospective cohort study of consecutive patients receiving potentially curative surgery for stage II and III primary rectal cancer. CRT was given only for magnetic resonance imaging-predicted circumferential resection margin (CRM) involvement and nodal disease (at least N2). Primary endpoints were CRM involvement and local recurrence rates. Secondary endpoints were systemic recurrence and overall survival. Data were analysed by log rank test, and univariable and multivariable analysis.
Between 2002 and 2012, 363 patients were treated for rectal cancer. After applying exclusion criteria, 266 patients with stage II/III mid or low rectal cancer were analysed. Of these, 103 received neoadjuvant CRT and 163 proceeded directly to surgery, seven of whom required postoperative radiotherapy; the latter patients were included in the neoadjuvant CRT group for analysis. There was a significant difference in local recurrence between the CRT and surgery-alone groups (6·5 versus 0 per cent at 5 years; P = 0·040), but not in CRM involvement (7·2 versus 5·1 per cent; P = 0·470), 5-year systemic recurrence (37·2 versus 43·0 per cent; P = 0·560) and overall survival (64·2 versus 64·6 per cent; P = 0·628) rates. Metastatic disease developed more frequently in low rectal cancers (odds ratio 0·14; P < 0·001), regardless of whether neoadjuvant treatment was delivered.
Locally advanced rectal cancer does not necessarily require neoadjuvant CRT.
本研究比较了在三级癌症中心行单纯手术与高度选择性术前放化疗（CRT）治疗 II/III 期直肠癌的治疗结果。
这是一项在连续接受 II 期和 III 期原发性直肠癌根治性手术的患者中进行的单中心回顾性队列研究。仅对 MRI 预测的环周切缘（CRM）受累和淋巴结疾病（至少 N2）的患者给予 CRT。主要终点为 CRM 受累和局部复发率。次要终点为全身复发和总生存率。采用对数秩检验、单变量和多变量分析对数据进行分析。
在 2002 年至 2012 年间，363 例直肠癌患者接受了治疗。在应用排除标准后，对 266 例 II/III 期中低位直肠癌患者进行了分析。其中 103 例接受了新辅助 CRT，163 例直接手术，其中 7 例需要术后放疗；后者被纳入新辅助 CRT 组进行分析。CRT 组与单纯手术组的局部复发率有显著差异（5 年时分别为 6.5%和 0%；P=0.040），但 CRM 受累率（分别为 7.2%和 5.1%；P=0.470）、5 年全身复发率（分别为 37.2%和 43.0%；P=0.560）和总生存率（分别为 64.2%和 64.6%；P=0.628）无显著差异。无论是否接受新辅助治疗，低位直肠癌更易发生远处转移（比值比 0.14；P<0.001）。
局部进展期直肠癌不一定需要新辅助 CRT。
