Yeung W Wk, Ma B By, Lee J Fy, Ng S Sm, Cheung M Hy, Ho W M, Tsang M Wk, Chu S, Lam D Cm, Mo F Kf
Department of Clinical Oncology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
Hong Kong Med J. 2016 Dec;22(6):546-55. doi: 10.12809/hkmj154788. Epub 2016 Oct 31.
To review the clinical outcome of locally advanced rectal cancer treated with neoadjuvant chemoradiation followed by definitive surgery with or without adjuvant chemotherapy and to elucidate the prognostic factors for treatment outcome.
This historical cohort study was conducted at a tertiary public hospital in Hong Kong. All patients who had undergone neoadjuvant chemoradiation for locally advanced rectal cancer in our department from November 2005 to October 2014 were recruited. Local recurrence-free survival, distant metastasis-free survival, disease-free survival, and overall survival of patients were documented.
A total of 135 patients who had received neoadjuvant chemoradiation during the study period were reviewed. There were 130 patients who had completed neoadjuvant chemoradiation and surgery. The median follow-up time was 35.1 months. The 3- and 5-year local recurrence-free survival, distant metastasis-free survival, disease-free survival, as well as overall survival rates were 91.8% and 86.7%, 73.9% and 72.1%, 70.1% and 64.6%, as well as 86.5% and 68.4%, respectively. The rate of pathological complete response was 13.8%. The T and N downstaging rate was 49.2% and 63.1%, respectively. The rate of conversion from threatened circumferential resection margin to clearance of margin was 90.6%. Of the 42 cases that were initially deemed to require abdominal perineal resection, 15 (35.7%) were converted to sphincter-sparing surgery.
The treatment outcome of neoadjuvant chemoradiation for locally advanced rectal cancer was comparable with overseas data in terms of local control rate and overall survival. This strategy may increase the chance of achieving a clear surgical margin by downstaging the tumour, especially in patients who presented with threatened circumferential margin.
回顾局部晚期直肠癌新辅助放化疗后行根治性手术（无论是否接受辅助化疗）的临床结局，并阐明治疗结局的预后因素。
本历史性队列研究在香港一家三级公立医院进行。纳入2005年11月至2014年10月期间在我科接受局部晚期直肠癌新辅助放化疗的所有患者。记录患者的局部无复发生存率、远处无转移生存率、无病生存率和总生存率。
共回顾了研究期间接受新辅助放化疗的135例患者。130例患者完成了新辅助放化疗和手术。中位随访时间为35.1个月。3年和5年的局部无复发生存率、远处无转移生存率、无病生存率以及总生存率分别为91.8%和86.7%、73.9%和72.1%、70.1%和64.6%以及86.5%和68.4%。病理完全缓解率为13.8%。T和N降期率分别为49.2%和63.1%。环周切缘受威胁转为切缘阴性的比例为90.6%。最初认为需要行腹会阴联合切除术的42例患者中，15例（35.7%）转为保留括约肌手术。
局部晚期直肠癌新辅助放化疗的治疗结局在局部控制率和总生存率方面与国外数据相当。该策略可能通过使肿瘤降期增加获得清晰手术切缘的机会，尤其是对于环周切缘受威胁的患者。
