1 Department of Radiology, Peking University People's Hospital, 11 Xizhimen S St, Xicheng District, Beijing 100044, China.
2 Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, China.
AJR Am J Roentgenol. 2018 Aug;211(2):327-334. doi: 10.2214/AJR.17.18980. Epub 2018 Jun 21.
The objective of this study was to compare the prognoses of patients with low- and high-risk rectal cancer detected by MRI who were treated without neoadjuvant chemoradiotherapy (NCRT) and to determine independent risk factors.
This retrospective study included 185 patients with pathologically proven rectal adenocarcinoma who were treated without NCRT. Cancer was defined as high risk if one or more of the following factors were present: extramural depth of tumor invasion greater than 5 mm or stage T4a or T4b for tumor in the mid or high rectum; involvement of intersphincteric space, levators, or adjacent organs for tumor in the low rectum; extramural venous invasion (EMVI); or circumferential resection margin (CRM) involvement. Patients without any of those risk factors were placed in the low-risk group. The Kaplan-Meier method and Cox proportional hazards regression model were used to compare the survival outcomes between the two groups and to investigate the univariate and multivariate influences of the risk factors.
Cancer was deemed to be low risk in 65 (35.1%) patients and high risk in 120 (64.9%) patients. The two patient groups had statistically significant differences in 3-year actuarial overall survival (OS; 100% vs 88.3%, p = 0.0044), disease-free survival (DFS; 92.3% vs 60.0%, p < 0.0001), and local recurrence (LR; 1.5% vs 10.0%, p = 0.0297). CRM involvement was identified as an independent risk factor for OS (hazard ratio [HR], 4.78; 95% CI, 1.24-18.45), DFS (HR, 2.44; 95% CI, 1.24-4.81), and LR (HR, 3.92; 95% CI, 1.07-14.41). Moreover, EMVI was identified as an independent risk factor for DFS (HR, 2.46; 95% CI, 1.28-4.74).
The LR and long-term survival of patients in the low-risk group were more favorable than those of patients in the high-risk group. EMVI and CRM status were independent risk factors.
本研究旨在比较未接受新辅助放化疗（NCRT）治疗的 MRI 检测出的低危和高危直肠癌患者的预后，并确定独立的危险因素。
本回顾性研究纳入了 185 例经病理证实的直肠腺癌患者，这些患者均未接受 NCRT 治疗。如果存在以下一个或多个因素，则定义为高危癌症：肿瘤外侵深度大于 5mm 或中高位直肠肿瘤 T4a 或 T4b 期；低位直肠肿瘤累及内外括约肌间隙、提肛肌或邻近器官；静脉外侵犯（EMVI）；或环周切缘（CRM）累及。无上述任何危险因素的患者归入低危组。采用 Kaplan-Meier 法和 Cox 比例风险回归模型比较两组的生存结局，并分析危险因素的单因素和多因素影响。
65 例（35.1%）患者被认为患有低危癌症，120 例（64.9%）患者患有高危癌症。两组患者在 3 年总生存率（OS；100% vs 88.3%，p = 0.0044）、无病生存率（DFS；92.3% vs 60.0%，p < 0.0001）和局部复发率（LR；1.5% vs 10.0%，p = 0.0297）方面存在统计学差异。CRM 累及被确定为 OS（风险比[HR]，4.78；95%CI，1.24-18.45）、DFS（HR，2.44；95%CI，1.24-4.81）和 LR（HR，3.92；95%CI，1.07-14.41）的独立危险因素。此外，EMVI 被确定为 DFS 的独立危险因素（HR，2.46；95%CI，1.28-4.74）。
低危组患者的 LR 和长期生存率优于高危组患者。EMVI 和 CRM 状态是独立的危险因素。
