放化疗联合局部切除术与标准切除术治疗 T2N0 期直肠癌的总生存相当：一项基于国家癌症数据库的分析。
Chemoradiation and Local Excision for T2N0 Rectal Cancer Offers Equivalent Overall Survival Compared to Standard Resection: a National Cancer Database Analysis.
机构信息
Center for Colon and Rectal Surgery, Florida Hospital, 2401 North Orange Ave, Suite 240, Orlando, FL, 32804, USA.
Department of Radiation Oncology, Florida Hospital, Orlando, FL, USA.
出版信息
J Gastrointest Surg. 2017 Oct;21(10):1666-1674. doi: 10.1007/s11605-017-3536-5. Epub 2017 Aug 17.
BACKGROUND
Local excision (LE) alone is associated with worse survival compared to radical surgery (RS) for T2 rectal cancer, but LE with additional chemoradiation (CRT) may improve outcomes. The objective of this study was to compare combined CRT and LE versus RS for T2 rectal cancer.
METHODS
The 2004-2014 National Cancer Database was queried for patients with T2N0M0 rectal cancer undergoing LE with neoadjuvant(NA-CRT + LE) or adjuvant(LE + Adj-CRT) CRT, or RS. The main outcome was 5-year overall survival (OS). Cox proportional hazards was used to determine the independent effect of treatment on OS.
RESULTS
A total of 4822 patients were included (4367 RS, 242 CRT + LE, 213 LE + Adj-CRT). Mean follow-up was 48.6 (SD28.5) months. There were no differences in patient characteristics, but more high-risk features in the LE + Adj-CRT group. There were no differences in 90-day mortality. Five-year OS was similar (RS 77.4% vs. CRT + LE 76.1% vs. LE + Adj-CRT 79.7%, p = 0.786). Older age, male gender, and higher Charlson score were independently associated with worse OS, whereas treatment type was not. If 90-day mortality was excluded, LE + Adj-CRT was independently associated with worse OS compared to RS.
CONCLUSIONS
CRT with LE for T2N0M0 rectal cancer was not associated with worse OS compared to RS, and may be a viable treatment modality.
背景
对于 T2 期直肠癌，单纯局部切除术（LE）与根治性手术（RS）相比，生存结局较差，但 LE 联合放化疗（CRT）可能改善结局。本研究旨在比较 T2 期直肠癌 CRT 联合 LE 与 RS 的治疗效果。
方法
本研究检索了 2004 年至 2014 年国家癌症数据库中接受新辅助（NA-CRT+LE）或辅助（LE+Adj-CRT）CRT 联合 LE 治疗或 RS 治疗的 T2N0M0 期直肠癌患者。主要结局为 5 年总生存（OS）。采用 Cox 比例风险模型确定治疗对 OS 的独立影响。
结果
共纳入 4822 例患者（4367 例 RS，242 例 CRT+LE，213 例 LE+Adj-CRT）。平均随访时间为 48.6（SD28.5）个月。患者特征无差异，但 LE+Adj-CRT 组高危特征更多。90 天死亡率无差异。5 年 OS 相似（RS 为 77.4%，CRT+LE 为 76.1%，LE+Adj-CRT 为 79.7%，p=0.786）。年龄较大、男性和较高的 Charlson 评分与 OS 较差独立相关，而治疗方式无关。如果排除 90 天死亡率，LE+Adj-CRT 与 RS 相比，OS 更差，是独立相关的。
结论
对于 T2N0M0 期直肠癌，LE 联合 CRT 与 RS 相比，OS 无差异，可能是一种可行的治疗方式。
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