Departments of Colorectal Surgery and Radiation Oncology, Beaumont Hospital, Dublin, Ireland.
Department of Surgery, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
Clin Colorectal Cancer. 2019 Dec;18(4):e361-e367. doi: 10.1016/j.clcc.2019.07.004. Epub 2019 Jul 11.
Preoperative radiation combined with mesorectal excision has reduced local recurrence rates in rectal cancer. The role for neoadjuvant therapy in upper third rectal cancer remains unclear. The current study aimed to use meta-analytical techniques to compare outcomes of upper third rectal tumors relative to those of the middle and lower rectum.
Meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies comparing outcomes between patients with upper third and more distal rectal cancer undergoing primary resection. Patients receiving neoadjuvant treatment were excluded. Results were reported as odds ratios (ORs) with 95% confidence intervals (95% CIs).
A total of 174 citations were reviewed; 5 studies comprising 3381 patients were included in the analysis. There was no difference in the rate of T3/4 tumors (OR, 1.303; 95% CI, 0.920-1.847; P = .137), lymph node positivity (OR, 1.004; 95% CI, 0.865-1.165; P = .961), and circumferential resection margin positivity (OR, 0.898; 95% CI, 0.556-1.450; P = .660) between upper third and more distal rectal cancers. However local recurrence (OR, 0.495; 95% CI, 0.302-0.811; P = .005) and distant recurrence (OR, 0.613; 95% CI, 0.511-0.734; P < .001) were reduced in patients with upper third rectal cancer.
These data suggest that upper third rectal cancer has reduced local and distant recurrence rates despite similarity in disease stage and margin positivity. Further studies examining effects of neoadjuvant radiation in rectal cancer should consider upper rectal tumors as a distinct entity to middle and lower rectal tumors.
术前放疗联合直肠系膜切除术降低了直肠癌的局部复发率。新辅助治疗在上段直肠癌中的作用尚不清楚。本研究旨在使用荟萃分析技术比较上段直肠肿瘤与中下段直肠肿瘤的结果。
使用系统评价和荟萃分析的首选报告项目（PRISMA）指南进行荟萃分析。搜索比较接受原发性切除术的上三分之一和更远段直肠肿瘤患者之间结局的研究数据库。排除接受新辅助治疗的患者。结果以优势比（OR）和 95%置信区间（95%CI）报告。
共审查了 174 篇引文；纳入 5 项研究，共 3381 例患者。T3/4 肿瘤的发生率（OR，1.303；95%CI，0.920-1.847；P=0.137）、淋巴结阳性率（OR，1.004；95%CI，0.865-1.165；P=0.961）和环周切缘阳性率（OR，0.898；95%CI，0.556-1.450；P=0.660）在上段和更远段直肠肿瘤之间无差异。然而，上三分之一直肠肿瘤的局部复发率（OR，0.495；95%CI，0.302-0.811；P=0.005）和远处复发率（OR，0.613；95%CI，0.511-0.734；P<0.001）降低。
尽管疾病分期和切缘阳性率相似，但这些数据表明上三分之一直肠肿瘤的局部和远处复发率降低。进一步研究新辅助放疗对直肠癌的影响时，应将上段直肠肿瘤视为与中下段直肠肿瘤不同的实体。
