Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Int J Clin Oncol. 2019 Jun;24(6):677-685. doi: 10.1007/s10147-019-01400-6. Epub 2019 Feb 5.
For rectal cancer, multimodality therapeutic approach is necessary to prevent local recurrence and distant metastasis. However, the efficacy of additional treatments, such as neoadjuvant chemoradiotherapy (nCRT), neoadjuvant chemotherapy (NAC), and lateral pelvic lymph node dissection (LPLND), has not been scrutinized.
Recurrence patterns were categorized into local recurrence and distant metastasis. Local recurrence was classified into two types: (1) pelvic cavity recurrence and (2) LPLN recurrence. First, we analyzed the risk factors for each recurrence pattern. Second, based on the status of clinically suspected involvement of circumferential resection margin (cCRM), the efficacy of additional treatments was investigated.
A total of 240 patients was enrolled. nCRT was performed for 25 (10%), NAC was for 46 (19%), and LPLND was for 35 patients (15%). As the recurrence patterns, pelvic cavity recurrence occurred in 15 (6%), LPLN recurrence in 8 (3%), and distant metastasis in 42 patients (18%). Five-year overall survival and relapse-free survival were 87% and 70%, respectively. Multivariate analysis indicated that pelvic cavity recurrence was associated with cCRM status and tumor histology, that LPLN recurrence was with serum carcinoembryonic antigen level and LPLN swelling, and that distant metastasis was with clinical N category. In the cCRM-positive subgroup (n = 66), cumulative rate of pelvic cavity recurrence was lower in the nCRT group than in the NAC or non-NAC/nCRT group (P = 0.02 and 0.09, respectively).
cCRM status was associated with pelvic cavity recurrence, and LPLN swelling was with LPLN recurrence. nCRT could reduce pelvic cavity recurrence in cCRM-positive subgroup.
对于直肠癌，需要采用多模式治疗方法以预防局部复发和远处转移。然而，新辅助放化疗（nCRT）、新辅助化疗（NAC）和侧方盆腔淋巴结清扫术（LPLND）等额外治疗的疗效尚未得到充分研究。
将复发模式分为局部复发和远处转移。局部复发分为两种类型：（1）盆腔复发；（2）LPLN 复发。首先，我们分析了每种复发模式的危险因素。其次，根据临床疑似环周切缘（cCRM）受累情况，探讨了额外治疗的疗效。
共纳入 240 例患者。25 例（10%）接受了 nCRT，46 例（19%）接受了 NAC，35 例（15%）接受了 LPLND。复发模式为盆腔复发 15 例（6%）、LPLN 复发 8 例（3%）和远处转移 42 例（18%）。5 年总生存率和无复发生存率分别为 87%和 70%。多因素分析表明，cCRM 状态和肿瘤组织学与盆腔复发相关，血清癌胚抗原水平和 LPLN 肿胀与 LPLN 复发相关，临床 N 分期与远处转移相关。在 cCRM 阳性亚组（n=66）中，nCRT 组的盆腔复发累积率低于 NAC 组或非 NAC/nCRT 组（P=0.02 和 0.09）。
cCRM 状态与盆腔复发相关，LPLN 肿胀与 LPLN 复发相关。nCRT 可降低 cCRM 阳性亚组的盆腔复发率。
