Westberg Karin, Palmer Gabriella, Hjern Fredrik, Johansson Hemming, Holm Torbjörn, Martling Anna
Department of Molecular Medicine and Surgery, Karolinska Institutet, Division of Surgery, Danderyd Hospital, S-182 88, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Center of Digestive Diseases, P9:03, Karolinska University Hospital, S-171 76, Stockholm, Sweden.
Eur J Surg Oncol. 2018 Jan;44(1):100-107. doi: 10.1016/j.ejso.2017.11.013. Epub 2017 Nov 26.
The rate of local recurrence of rectal cancer (LRRC) has decreased but the condition remains a therapeutic challenge. This study aimed to examine treatment and prognosis in patients with LRRC in Sweden. Special focus was directed towards potential differences between geographical regions and time periods.
All patients with LRRC as first event, following primary surgery for rectal cancer performed during the period 1995-2002, were included in this national population-based cohort-study. Data were collected from the Swedish Colorectal Cancer Registry and from medical records. The cohort was divided into three time periods, based on the date of diagnosis of the LRRC.
In total, 426 patients fulfilled the inclusion criteria. Treatment with curative intent was performed in 149 patients (35%), including 121 patients who had a surgical resection of the LRRC. R0-resection was achieved in 64 patients (53%). Patients with a non-centrally located tumour were more likely to have positive resection margins (R1/R2) (OR 5.02, 95% CI:2.25-11.21). Five-year survival for patients resected with curative intent was 43% after R0-resection and 14% after R1-resection. There were no significant differences in treatment intention or R0-resection rate between time periods or regions. The risk of any failure was significantly higher in R1-resected patients compared with R0-resected patients (HR 2.04, 95% CI:1.22-3.40).
A complete resection of the LRRC is essential for potentially curative treatment. Time period and region had no influence on either margin status or prognosis.
直肠癌局部复发（LRRC）率虽已下降，但仍是一个治疗难题。本研究旨在探讨瑞典LRRC患者的治疗及预后情况。特别关注地理区域和时间段之间的潜在差异。
本全国性基于人群的队列研究纳入了1995 - 2002年期间因直肠癌接受初次手术后首次发生LRRC的所有患者。数据从瑞典结直肠癌登记处和病历中收集。根据LRRC的诊断日期，将队列分为三个时间段。
共有426例患者符合纳入标准。149例患者（35%）接受了根治性治疗，其中121例患者接受了LRRC手术切除。64例患者（53%）实现了R0切除。肿瘤非中心部位的患者更有可能出现切缘阳性（R1/R2）（比值比5.02，95%置信区间：2.25 - 11.21）。根治性切除患者的五年生存率在R0切除后为43%，R1切除后为14%。时间段或地区之间在治疗意图或R0切除率方面无显著差异。与R0切除患者相比，R1切除患者任何失败的风险显著更高（风险比2.04，95%置信区间：1.22 - 3.40）。
LRRC的完整切除对于潜在的根治性治疗至关重要。时间段和地区对切缘状态或预后均无影响。
