Wan Juefeng, Liu Kaitai, Zhu Ji, Li Guichao, Zhang Zhen
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Oncotarget. 2015 May 10;6(13):11714-22. doi: 10.18632/oncotarget.3418.
Local excision may offer the possibility of organ preservation for the management of locally advanced rectal cancer after neoadjuvant chemoradiotherapy (CRT). However, the oncological outcomes of this strategy have been largely associated with the risk of nodal metastases. In this study, Surveillance, Epidemiology, and End Results Program (SEER)-registered rectal cancer patients, and patients from Fudan University Shanghai Cancer Center (FUSCC) after preoperative chemoradiation were combined to analyze the incidence of lymph node metastasis. The results showed that there was a high risk for residual lymph node metastasis among patients even with complete pathologic response of primary tumor after preoperative CRT (12.6-13.2%). However, in the selected group of patients with pre-CRT MRI staging cN0 rectal cancer, there was only one ypN+ case (3.3%) in ypT0-1 group. These results suggest that pre-CRT MRI staging cN0 patients achieved ypT0-1 of bowel wall tumor may be suitable for local resection.
局部切除可能为新辅助放化疗（CRT）后局部晚期直肠癌的器官保留管理提供可能性。然而，该策略的肿瘤学结局在很大程度上与淋巴结转移风险相关。在本研究中，将监测、流行病学和最终结果计划（SEER）注册的直肠癌患者以及复旦大学附属上海肿瘤中心（FUSCC）术前接受放化疗后的患者合并起来分析淋巴结转移发生率。结果显示，即使术前CRT后原发肿瘤达到完全病理缓解，患者仍存在残留淋巴结转移的高风险（12.6%-13.2%）。然而，在CRT前MRI分期为cN0直肠癌的选定患者组中，ypT0-1组仅出现1例ypN+病例（3.3%）。这些结果表明，CRT前MRI分期为cN0且肠壁肿瘤达到ypT0-1的患者可能适合局部切除。
