Sun Yanwu, Chi Pan, Lin Huiming, Lu Xingrong, Huang Ying, Xu Zongbing, Huang Shenghui, Ye Daoxiong, Wang Xiaojie
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Apr;19(4):436-41.
To clarify the natural course and explore impact factors of distant metastasis in rectal cancer patients who received total mesorectal excision(TME) following neoadjuvant chemoradiotherapy (CRT).
Between Januray 2008 and December 2013, 317 patients with locally advanced rectal cancer who underwent radical surgical resection following neoadjuvant CRT (pre- and postoperative simple fluorouracil or fluorouracil combined with oxaliplatin plus preoperative three dimensional conformal radiotherapy) at Department of Colorectal Surgery in Fujian Medical University Union Hospital were included. Univariate analysis and Cox regression were performed to evaluate the clinicopathological parameters that may be associated with distant metastasis.
During a median follow-up of 39 months(range 15 - 89 months), 72 patients(22.7%) had disease recurrence, including local recurrence in 8 patients, and distant metastasis in 67 patients (among whom 3 patients had both). Distant metastasis occurred in 86.5%(58/67) patients during the first three years after surgery. The 3-year cumulative distant metastatic rate in all the patients was 22.4%. The 5-year overall survival rate in distant metastatic patient was significantly lower than that of non-distant metastatic patients following neoadjuvant CRT (36.2% vs. 81.2%, P=0.000). Univariate analysis showed that ypT stage (χ(2)=13.304, P=0.010), ypN stage(χ(2)=23.416, P=0.000), ypTNM stage (χ(2)=31.765, P=0.000) and RCRG(χ(2)=16.246, P=0.000) were associated with distant metastasis. Cox regression revealed that ypTNM stage(HR=1.959, 95% CI:1.171 ~ 3.277, P=0.010) was the only independent risk factor of distant metastasis.
Distant metastasis is the early event during the progression in rectal cancer. ypTNM stage is the only independent risk factor of distant metastasis in locally advanced rectal cancer patients who undergo TME following neoadjuvant CRT.
明确接受新辅助放化疗（CRT）后行全直肠系膜切除术（TME）的直肠癌患者远处转移的自然病程并探索其影响因素。
纳入2008年1月至2013年12月间在福建医科大学附属协和医院结直肠外科接受新辅助CRT（术前和术后单纯氟尿嘧啶或氟尿嘧啶联合奥沙利铂加术前三维适形放疗）后行根治性手术切除的317例局部晚期直肠癌患者。进行单因素分析和Cox回归以评估可能与远处转移相关的临床病理参数。
在中位随访39个月（范围15 - 89个月）期间，72例患者（22.7%）出现疾病复发，其中8例为局部复发，67例为远处转移（其中3例同时有局部复发和远处转移）。86.5%（58/67）的患者在术后前三年发生远处转移。所有患者的3年累积远处转移率为22.4%。新辅助CRT后远处转移患者的5年总生存率显著低于未发生远处转移的患者（36.2%对81.2%，P = 0.000）。单因素分析显示，ypT分期（χ(2)=13.304，P = 0.010）、ypN分期（χ(2)=23.416，P = 0.000）、ypTNM分期（χ(2)=31.765，P = 0.000）和RCRG（χ(2)=16.246，P = 0.000）与远处转移有关。Cox回归显示ypTNM分期（HR = 1.959，95%CI：1.171～3.277，P = 0.010）是远处转移的唯一独立危险因素。
远处转移是直肠癌进展过程中的早期事件。ypTNM分期是新辅助CRT后行TME的局部晚期直肠癌患者远处转移的唯一独立危险因素。
