Takiyama Hirotoshi, Kawai Kazushige, Ishihara Soichiro, Yasuda Koji, Otani Kensuke, Nishikawa Takeshi, Tanaka Toshiaki, Kiyomatsu Tomomichi, Hata Keisuke, Nozawa Hiroaki, Morikawa Teppei, Watanabe Toshiaki
Department of Surgical Oncology, The University of Tokyo Hospital, Tokyo, Japan.
Dig Surg. 2018;35(3):212-219. doi: 10.1159/000477778. Epub 2017 Jun 21.
BACKGROUND/AIMS: The neoadjuvant therapy for locally advanced rectal cancer has been changed from radiotherapy (RT) to chemoradiotherapy (CRT). This study is aimed at evaluating the benefit of CRT in patients with stage II or III lower rectal cancer, with regard to the impact on recurrence.
A total of 474 patients with clinical stage II or III lower rectal cancer who received either preoperative RT (n = 221) or CRT (n = 253) followed by total mesorectal excision were identified from our institutional database. Propensity score analysis was performed to mitigate selection biases.
Among stage II patients, the CRT group showed a significantly lower 5-year local recurrence rate than the RT group (3.0 vs. 14.8%, p = 0.002). In contrast, among stage III patients, the CRT group showed a significantly lower 5-year distant recurrence rate than the RT group (27.8 vs. 42.6%, p = 0.04) and also a better 5-year recurrence-free survival (64.2 vs. 48.3%, p = 0.03).
Addition of concurrent chemotherapy to preoperative RT significantly enhanced the local control in stage II patients and decreased distant recurrence in stage III patients. The oncological benefit of CRT may differ between patients with stage II or III rectal cancer.
背景/目的：局部晚期直肠癌的新辅助治疗已从单纯放疗（RT）转变为放化疗（CRT）。本研究旨在评估CRT对II期或III期低位直肠癌患者复发情况的影响，以确定其益处。
从我院机构数据库中识别出474例临床II期或III期低位直肠癌患者，这些患者接受了术前RT（n = 221）或CRT（n = 253），随后进行了全直肠系膜切除术。采用倾向评分分析以减轻选择偏倚。
在II期患者中，CRT组的5年局部复发率显著低于RT组（3.0%对14.8%，p = 0.002）。相比之下，在III期患者中，CRT组的5年远处复发率显著低于RT组（27.8%对42.6%，p = 0.04），5年无复发生存率也更好（64.2%对48.3%，p = 0.03）。
术前RT联合同步化疗可显著增强II期患者的局部控制，并降低III期患者的远处复发。CRT在II期或III期直肠癌患者中的肿瘤学益处可能有所不同。
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