Cho Min Soo, Park Youn Young, Yoon Jiho, Yang Seung Yoon, Baik Seung Hyuk, Lee Kang Young, Kim Ik Yong, Kim Nam Kyu
The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
The Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Seoul, Korea.
J Surg Oncol. 2018 Jun;117(8):1823-1832. doi: 10.1002/jso.25064. Epub 2018 May 22.
This study aimed to determine the prognostic value of baseline magnetic resonance imaging-based extramural vascular invasion status (EMVI) among rectal cancer patients with a good tumor response to standard chemoradiotherapy followed by surgery.
A total of 359 patients with ypT0-2/N0 disease from The Yonsei Multicenter Colorectal Cancer Electronic Database were retrospectively included between January 2000 and December 2014. Magnetic resonance images and medical records were reviewed to investigate risk factors for tumor recurrence.
When we compared patients without and with EMVI, significant differences were observed in the 5-year disease-free survival rate (DFS) (80.8% vs 57.8%, P = 0.005) and in the 5-year systemic recurrence-free survival rate (SRFS) (86.9% vs 64.3%, P = 0.007). In the multivariate analysis, both mrEMVI and APR independently predicted overall DFS (APR; HR 2.088, 95% CI: 1.082-4.031, P = 0.028, mrEMVI; HR: 2.729, 95% CI: 1.230-6.058, P = 0.014). mrEMVI was only independent prognostic factor for systemic recurrence with statistical significance (HR: 3.321, 95% CI: 1.185-9.309, P = 0.022).
Even in rectal cancer patients with a good response to chemoradiotherapy followed by curative surgery, extramural vascular invasion and APR may predict poor disease-free survival outcomes. Intensified treatment strategy should be considered.
本研究旨在确定基线磁共振成像（MRI）评估的壁外血管侵犯状态（EMVI）在对标准放化疗有良好肿瘤反应并随后接受手术的直肠癌患者中的预后价值。
回顾性纳入2000年1月至2014年12月期间来自延世多中心结直肠癌电子数据库的359例ypT0 - 2/N0疾病患者。回顾磁共振图像和病历以研究肿瘤复发的危险因素。
当我们比较无EMVI和有EMVI的患者时，观察到5年无病生存率（DFS）（80.8%对57.8%，P = 0.005）和5年全身无复发生存率（SRFS）（86.9%对64.3%，P = 0.007）存在显著差异。在多变量分析中，mrEMVI和APR均独立预测总体DFS（APR；HR 2.088，95% CI：1.082 - 4.031，P = 0.028，mrEMVI；HR：2.729，95% CI：1.230 - 6.058，P = 0.014）。mrEMVI是全身复发的唯一具有统计学意义的独立预后因素（HR：3.321，95% CI：1.185 - 9.309，P = 0.022）。
即使在对放化疗有良好反应并随后接受根治性手术的直肠癌患者中，壁外血管侵犯和APR也可能预示无病生存结局不佳。应考虑强化治疗策略。
