Cho Seung Hyun, Choi Gyu-Seog, Kim Gab Chul, Seo An Na, Kim Hye Jung, Kim Won Hwa, Shin Kyung-Min, Lee So Mi, Ryeom Hunkyu, Kim See Hyung
Department of Radiology Colorectal Cancer Center Department of Pathology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University Department of Radiology, Dongsan Hospital, College of Medicine, Keimyung University, Daegu, Republic of Korea.
Medicine (Baltimore). 2017 Mar;96(12):e6362. doi: 10.1097/MD.0000000000006362.
Recently, a few studies have raised the question of whether preoperative chemoradiotherapy (PCRT) is essential for all T3 rectal cancers. This case-matched study aimed to compare the long-term outcomes of surgery alone with those of PCRT + surgery for magnetic resonance imaging (MRI)-assessed T3ab (extramural depth of invasion ≤5 mm) and absent mesorectal fascia invasion (clear MRF) in mid/lower rectal cancer patients.From January 2006 to November 2012, 203 patients who underwent curative surgery alone (n = 118) or PCRT + surgery (n = 85) were enrolled in this retrospective study. A 1:1 propensity score-matched analysis was performed to eliminate the inherent bias. Case-matching covariates included age, sex, body mass index, histologic grade, carcinoembryonic antigen, operation method, follow-up period, tumor height, and status of lymph node metastasis. The end-points were the 5-year local recurrence (LR) rate and disease-free-survival (DFS).After propensity score matching, 140 patients in 70 pairs were included. Neither the 5-year LR rate nor the DFS was significantly different between the 2 groups (the 5-year LR rate, P = 0.93; the 5-year DFS, P = 0.94). The 5-year LR rate of the surgery alone was 2% (95% confidence interval [CI] 0.2%-10.9%) versus 2% (95% CI 0.2%-10.1%) in the PCRT + surgery group. The 5-year DFS of the surgery alone was 87% (95% CI 74.6%-93.7%) versus 88% (95% CI 77.8%-93.9%) in the PCRT + surgery group.In patients with MRI-assessed T3ab and clear MRF mid/lower rectal cancer, the long-term outcomes of surgery alone were comparable with those of the PCRT + surgery. The suggested MRI-assessed T3ab and clear MRF can be used as a highly selective indication of surgery alone in mid/lower T3 rectal cancer. Additionally, in those patients, surgery alone can be tailored to the clinical situation.
最近，一些研究提出了术前放化疗（PCRT）是否对所有T3期直肠癌都必不可少的问题。这项病例对照研究旨在比较单纯手术与PCRT联合手术对磁共振成像（MRI）评估为T3ab（壁外浸润深度≤5mm）且无直肠系膜筋膜侵犯（MRF阴性）的中低位直肠癌患者的长期疗效。
2006年1月至2012年11月，203例接受单纯根治性手术（n = 118）或PCRT联合手术（n = 85）的患者纳入这项回顾性研究。进行1:1倾向评分匹配分析以消除内在偏倚。病例匹配协变量包括年龄、性别、体重指数、组织学分级、癌胚抗原、手术方式、随访时间、肿瘤高度和淋巴结转移情况。终点指标为5年局部复发（LR）率和无病生存期（DFS）。
倾向评分匹配后，纳入70对共140例患者。两组的5年LR率和DFS均无显著差异（5年LR率，P = 0.93；5年DFS，P = 0.94）。单纯手术组的5年LR率为2%（95%置信区间[CI] 0.2% - 10.9%），PCRT联合手术组为2%（95%CI 0.2% - 10.1%）。单纯手术组的5年DFS为87%（95%CI 74.6% - 93.7%），PCRT联合手术组为88%（95%CI 77.8% - 93.9%）。
对于MRI评估为T3ab且MRF阴性的中低位直肠癌患者，单纯手术的长期疗效与PCRT联合手术相当。提示MRI评估为T3ab且MRF阴性可作为中低位T3期直肠癌单纯手术的高度选择性指征。此外，对于这些患者，单纯手术可根据临床情况进行调整。
