Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Medical Foundation, Chiayi Branch, No. 6, Sec. West, Chia-Pu Road, Putz City, Chiayi Hsien 613, Chiayi, Taiwan.
Graduate Institute of Clinical Medicine, Chang Gung University, Linkuo, Taiwan.
BMC Cancer. 2019 Aug 17;19(1):815. doi: 10.1186/s12885-019-6019-0.
Current advancements in neoadjuvant therapy and total mesorectal excision have engendered increased local control. However, the survival benefit of preoperative radiotherapy (RT; 5 × 5 Gy) in rectal cancer patients remains inadequate, primarily because of systemic recurrence. In this retrospective single-center study, the effects of monthly tegafur-uracil maintenance (≥6 cycles) after 12 fluorouracil-based adjuvant chemotherapy cycles on 3-year relapse-free survival (RFS) was estimated in ypStage III rectal cancer patients.
Of ypStage III rectal cancer patients who received preoperative RT (5 × 5 Gy) in January 2006-December 2015, those who had ypStage III cancer after preoperative radiation, radical resection, and postoperative chemotherapy were enrolled; excluded patients had ypStage I and II rectal cancer, had double cancer, had synchronous distant metastasis, had local excision, received preoperative chemoradiation, and were lost to follow-up within 1 year after cancer treatment. Included patients received either maintenance therapy or observation after postoperative chemotherapy. The primary endpoint was the effect of maintenance therapy on 3-year RFS. We set the median follow-up duration to be 69.7 (range, 15.4-148.3) months.
Of 259 ypStage III rectal cancer patients, 102 (59 men and 43 women) were enrolled based on the inclusion criteria. The maintenance and observation groups comprised 55 and 57 patients, respectively (mean age = 62.2 and 65.7 years, respectively; p = 0.185). The 3-year RFS observed in the maintenance group (85.1%) was longer than that observed in the observation group (67.5%; p = 0.039). Multivariate analysis proved the following to be independent prognostic factors for RFS: higher metastatic lymph node ratio (LNR ≥0.3), tegafur-uracil maintenance (≥6 cycles), and lower rectal cancer (< 6 cm from the anal verge). The higher the rectal cancer location (≥6 cm from the anal verge) was, the higher the tegafur-uracil maintenance survival benefit became (p = 0.041). Moreover, lower cancer location (< 6 cm from the anal verge) and LNR ≥0.3 were both associated with a trend of longer RFS after tegafur-uracil maintenance therapy (p = 0.164 and 0.113, respectively).
After the execution of fluorouracil-based adjuvant chemotherapy, administering monthly tegafur-uracil (≥6 cycles) may improve the 3-year RFS of ypStage III rectal cancer patients.
新辅助治疗和全直肠系膜切除术的当前进展带来了更高的局部控制率。然而，术前放疗（RT；5×5 Gy）在直肠癌患者中的生存获益仍然不足，主要是因为出现了全身复发。在这项回顾性单中心研究中，我们评估了接受氟尿嘧啶辅助化疗 12 个周期后每月替加氟-尿嘧啶维持（≥6 个周期）对 ypIII 期直肠癌患者 3 年无复发生存（RFS）的影响。
在 2006 年 1 月至 2015 年 12 月接受术前 RT（5×5 Gy）的 ypIII 期直肠癌患者中，我们纳入了接受术前放疗、根治性切除和术后化疗后ypIII 期癌症的患者；排除了 ypI 和 II 期直肠癌、合并第二原发癌、同步远处转移、局部切除、术前放化疗和癌症治疗后 1 年内失访的患者。纳入的患者在术后化疗后接受维持治疗或观察。主要终点是维持治疗对 3 年 RFS 的影响。我们将中位随访时间设定为 69.7 个月（范围，15.4-148.3）。
在 259 名 ypIII 期直肠癌患者中，根据纳入标准，有 102 名（59 名男性和 43 名女性）患者被纳入。维持组和观察组分别有 55 名和 57 名患者（平均年龄分别为 62.2 和 65.7 岁；p=0.185）。维持组 3 年 RFS 为 85.1%，长于观察组的 67.5%（p=0.039）。多变量分析证实，以下因素是 RFS 的独立预后因素：较高的转移性淋巴结比率（LNR≥0.3）、替加氟-尿嘧啶维持（≥6 个周期）和较低的直肠肿瘤（距肛缘＜6cm）。直肠肿瘤位置越高（距肛缘≥6cm），替加氟-尿嘧啶维持的生存获益越高（p=0.041）。此外，较低的肿瘤位置（距肛缘＜6cm）和 LNR≥0.3 均与替加氟-尿嘧啶维持治疗后更长的 RFS 相关（p=0.164 和 0.113）。
在氟尿嘧啶辅助化疗后，每月给予替加氟-尿嘧啶（≥6 个周期）可能会改善 ypIII 期直肠癌患者的 3 年 RFS。
