Jeong Seong-A, Park In Ja, Hong Seung Mo, Bong Jun Woo, Choi Hye Yoon, Seo Ji Hyun, Kim Hyong Eun, Lim Seok-Byung, Yu Chang Sik, Kim Jin Cheon
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2019 Feb;96(2):78-85. doi: 10.4174/astr.2019.96.2.78. Epub 2018 Jan 30.
Insistence that total regression of primary tumor would not represent long-term oncologic outcomes has been raised. Therefore, this study aimed to evaluate the outcomes of these patients after preoperative chemoradiotherapy (PCRT) and radical surgery and to evaluate the associated risk factors.
We included 189 patients with rectal cancer who showed total regression of the primary tumor after PCRT, followed by radical resection, between 2001 and 2012. Recurrence-free survival (RFS) was calculated using the Kaplan-Meier method, and the results were compared with 77 patients with Tis rectal cancer who received only radical resection. Factors associated with RFS were evaluated using Cox regression analysis.
Sphincter-saving resection was performed for 146 patients (77.2%). Adjuvant chemotherapy was administered to 168 patients (88.9%). During the follow-up period, recurrence occurred in 17 patients (9%). The 5-year RFS was 91.3%, which was significantly lower than that of patients with Tis rectal cancer without PCRT (P = 0.005). In univariate analysis, preoperative CEA and histologic differentiation were associated with RFS. However, no factors were found to be associated with RFS.
RFS was lower in patients with total regression of primary rectal cancer after PCRT than in those with Tis rectal cancer without PCRT, and it would not be considered as the same entity with early rectal cancer or "disappeared tumor" status.
有人提出，原发性肿瘤完全消退并不代表长期肿瘤学结局。因此，本研究旨在评估这些患者术前放化疗（PCRT）及根治性手术后的结局，并评估相关危险因素。
我们纳入了189例2001年至2012年间经PCRT后原发性肿瘤完全消退并接受根治性切除的直肠癌患者。采用Kaplan-Meier法计算无复发生存期（RFS），并将结果与77例仅接受根治性切除的Tis期直肠癌患者进行比较。使用Cox回归分析评估与RFS相关的因素。
146例患者（77.2%）接受了保留括约肌切除术。168例患者（88.9%）接受了辅助化疗。随访期间，17例患者（9%）出现复发。5年RFS为91.3%，显著低于未接受PCRT的Tis期直肠癌患者（P = 0.005）。单因素分析显示，术前癌胚抗原（CEA）和组织学分化与RFS相关。然而，未发现与RFS相关的因素。
PCRT后原发性直肠癌完全消退的患者的RFS低于未接受PCRT的Tis期直肠癌患者，且不应将其视为与早期直肠癌或“肿瘤消失”状态相同的情况。
