Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong Special Administrative Region.
Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong Special Administrative Region; Department of Clinical Oncology, The University of Hong Kong, Hong Kong Special Administrative Region; Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, China.
J Formos Med Assoc. 2018 Sep;117(9):825-832. doi: 10.1016/j.jfma.2017.10.002. Epub 2017 Nov 1.
For advanced rectal cancer with involved or threatened mesorectal fascia (MRF), current standard is pre-operative long course chemoradiotherapy (PLCRT) with either capecitabine or 5-fluorouracil (5-FU). However, few Chinese data on its clinical outcome are available, especially for those with pelvic MRI staging.
Between Jan-2009 and Oct-2014, 123 consecutive patients with biopsy proven adenocarcinoma of rectum, all with pelvic MRI staging, selected for PLCRT after multi-disciplinary team discussion were recruited. Their clinical records were retrospectively reviewed.
Median follow-up was 1392 days (range: 48-2886) MRI defined poor risk factors as follows: MRF threatened or involved ≤1 mm 61.8% (n = 76), cT4 13.8% (n = 17), cN2 26.8% (n = 33) and low-lying tumor (≤5 cm from anal verge) 24.4% (n = 30). Five year OS and DFS were 63.9% and 68.3% respectively. Among 112 patients who received TME, 108 (96.4%) had microscopic clear resection (R0). Twelve and 32 individuals had pathological complete response and ypT0-2N0, respectively. Five local recurrences (4.5%) were detected. The incidence of grade 3 or above acute and late radiotherapy toxicity was 8.1% and 12.2% respectively. After multivariate adjustment, positive circumferential resection margin (CRM) status on pathology report was found to be significant factor for worse OS and DFS.
The clinical outcomes of PLCRT in our institution are comparable with those in western literature. Our MRI staging lends support to the validity of data. CRM status is the most significant prognostic factor in OS and DFS, after multivariate adjustment.
对于累及或有中高位直肠系膜筋膜（MRF）侵犯风险的局部进展期直肠癌，目前的标准治疗方案是术前长程放化疗（PLCRT），方案包括卡培他滨或氟尿嘧啶（5-FU）。然而，中国缺乏相关的临床数据，特别是针对那些接受盆腔 MRI 分期的患者。
2009 年 1 月至 2014 年 10 月，我们共招募了 123 例经组织学证实的直肠腺癌患者，所有患者均接受了盆腔 MRI 分期，且经多学科团队讨论后选择接受 PLCRT。我们对这些患者的临床资料进行了回顾性分析。
中位随访时间为 1392 天（范围：48-2886 天）。MRI 定义的不良预后因素包括：MRF 受侵或累及<1mm 61.8%（n=76），cT4 13.8%（n=17），cN2 26.8%（n=33）和低位肿瘤（肿瘤下缘距肛缘<5cm）24.4%（n=30）。5 年总生存率和无病生存率分别为 63.9%和 68.3%。在接受全直肠系膜切除术（TME）的 112 例患者中，108 例（96.4%）达到了显微镜下的完全切除（R0）。12 例和 32 例患者病理完全缓解和ypT0-2N0，分别。共发现 5 例局部复发（4.5%）。3 级或以上急性和晚期放疗毒性的发生率分别为 8.1%和 12.2%。多因素调整后发现，病理报告中阳性环周切缘（CRM）状态是总生存和无病生存的显著预后因素。
我们机构的 PLCRT 临床结果与西方文献报道相似。我们的 MRI 分期支持数据的有效性。CRM 状态是多因素调整后总生存和无病生存的最重要预后因素。
