Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Eur J Surg Oncol. 2020 Nov;46(11):2057-2063. doi: 10.1016/j.ejso.2020.07.019. Epub 2020 Jul 25.
The definition of "early recurrence (ER)" after rectal cancer surgery is currently unclear.
To determine an evidence-based cut-off to distinguish early and late recurrence (LR) for patients with rectal cancer and compare the clinicopathological factors between the two groups.
Patients who underwent neoadjuvant chemoradiotherapy (nCRT) and radical resection for locally advanced rectal cancer were included. A minimum p-value approach was used to evaluate the optimal cut-off value of recurrence-free survival to divide the patients into ER and LR groups based on overall survival. A logistic regression model was used to assess risk factors for ER.
A total of 763 patients were included, of which 167 (21.9%) experienced recurrence. The optimal cut-off value of recurrence-free survival to differentiate between ER (n = 125, 74.9%) and LR (n = 42, 25.1%) was 24 months (P = 0.000001). The median postrecurrence survival of ER and LR was 12 months and 22 months, respectively (p = 0.028). The most common recurrent sites in patients with ER and LR were lung metastases, the incidence of liver metastases, however, differed considerably in ER and LR (27.2% vs 9.5%, P = 0.019). Risk factors including elevated preoperative carcinoembryonic antigen (CEA), higher ypTNM stage, positive circumferential resection margin (CRM), and perineural invasion were significantly associated with ER.
A recurrence-free interval of 24 months is the optimal cut-off value for defining ER versus LR. Elevated preoperative CEA, higher ypTNM staging, positive CRM, and perineural invasion were associated with ER of locally advanced rectal cancer.
直肠癌手术后“早期复发（ER）”的定义目前尚不清楚。
确定一个基于证据的截止值，以区分直肠癌患者的早期和晚期复发（LR），并比较两组的临床病理因素。
纳入接受新辅助放化疗（nCRT）和根治性切除术的局部进展期直肠癌患者。采用最小 P 值法评估无复发生存的最佳截止值，根据总生存情况将患者分为 ER 和 LR 组。采用 logistic 回归模型评估 ER 的危险因素。
共纳入 763 例患者，其中 167 例（21.9%）发生复发。无复发生存的最佳截止值来区分 ER（n=125，74.9%）和 LR（n=42，25.1%）为 24 个月（P=0.000001）。ER 和 LR 的中位复发后生存时间分别为 12 个月和 22 个月（p=0.028）。ER 和 LR 患者最常见的复发病灶是肺转移，而肝转移的发生率在 ER 和 LR 中差异较大（27.2%比 9.5%，P=0.019）。术前癌胚抗原（CEA）升高、ypTNM 分期较高、环周切缘阳性（CRM）和神经周围侵犯等危险因素与 ER 显著相关。
无复发生存期 24 个月是定义 ER 与 LR 的最佳截止值。术前 CEA 升高、ypTNM 分期较高、CRM 阳性和神经周围侵犯与局部进展期直肠癌的 ER 相关。
