Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Colorectal Dis. 2019 Mar;21(3):315-325. doi: 10.1111/codi.14535. Epub 2019 Jan 17.
The prognostic association between mesorectal grading and oncological outcome in patients undergoing resection for rectal adenocarcinoma is controversial. The aim of this retrospective chart review was to determine the individual impact of mesorectal grading on rectal cancer outcomes.
We compared oncological outcomes in patients with complete, near-complete and incomplete mesorectum who underwent rectal excision with curative intent from 2009 to 2014 for Stage cI-III rectal adenocarcinoma. We also assessed the independent association of mesorectal grading and oncological outcome using multivariate models including other relevant variables.
Out of 505 patients (339 men, median age of 60 years), 347 (69%) underwent a restorative procedure. There were 452 (89.5%), 33 (6.5%) and 20 (4%) patients with a complete, near-complete and incomplete mesorectum, respectively. Local recurrence was seen in 2.4% (n = 12) patients after a mean follow-up of 3.1 ± 1.7 years. Unadjusted 3-year Kaplan-Meier analysis by mesorectal grade showed decreased rates of overall, disease-free and cancer-specific survival and increased rates of overall and distant recurrence with a near-complete mesorectum, while local recurrence was increased in cases of an incomplete mesorectum (all P < 0.05). On multivariate analyses, a near-complete mesorectum was independently associated with decreased cancer-specific survival (hazard ratio 0.26, 95% CI 0.1-0.7; P = 0.007). There were no associations between mesorectal grading and overall survival, disease-free survival, overall recurrence or distant recurrence (all P > 0.05).
Mesorectal grading is independently associated with oncological outcome. It provides unique information for optimizing surgical quality in rectal cancer.
在接受直肠腺癌切除术的患者中，中直肠分级与肿瘤学结果之间的预后相关性存在争议。本回顾性图表回顾的目的是确定中直肠分级对直肠癌结果的个体影响。
我们比较了 2009 年至 2014 年间接受根治性直肠切除术治疗 cI-III 期直肠腺癌的完全、接近完全和不完全中直肠患者的肿瘤学结果。我们还使用包括其他相关变量的多变量模型评估了中直肠分级和肿瘤学结果的独立关联。
在 505 名患者（339 名男性，中位年龄 60 岁）中，347 名（69%）接受了恢复性手术。分别有 452 名（89.5%）、33 名（6.5%）和 20 名（4%）患者的中直肠完全、接近完全和不完全。在平均随访 3.1±1.7 年后，2.4%（n=12）的患者出现局部复发。未调整的 3 年 Kaplan-Meier 分析显示，中直肠分级为接近完全时，总生存率、无病生存率和癌症特异性生存率降低，总复发率和远处复发率增加，而中直肠不完全时局部复发率增加（均 P<0.05）。多变量分析显示，接近完全的中直肠与癌症特异性生存率降低独立相关（风险比 0.26，95%CI 0.1-0.7；P=0.007）。中直肠分级与总生存率、无病生存率、总复发率或远处复发率之间无关联（均 P>0.05）。
中直肠分级与肿瘤学结果独立相关。它为优化直肠癌的手术质量提供了独特的信息。
