Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain; Department of General Surgery, Colorectal Surgery Unit, Hospital Valle de Hebron, Autonomous University of Barcelona, Barcelona, Spain.
Colorectal Unit, Hospital Universitario y Politecnico La Fe, University of Valencia, Spain.
Eur J Surg Oncol. 2021 Feb;47(2):276-284. doi: 10.1016/j.ejso.2020.04.056. Epub 2020 Aug 18.
Preoperative treatment and adequate surgery increase local control in rectal cancer. However, modalities and indications for neoadjuvant treatment may be controversial. Aim of this study was to assess the trends of preoperative treatment and outcomes in patients with rectal cancer included in the Rectal Cancer Registry of the Spanish Associations of Surgeons.
This is a STROBE-compliant retrospective analysis of a prospective database. All patients operated on with curative intention included in the Rectal Cancer Registry were included. Analyses were performed to compare the use of neoadjuvant/adjuvant treatment in three timeframes: I)2006-2009; II)2010-2013; III)2014-2017. Survival analyses were run for 3-year survival in timeframes I-II.
Out of 14,391 patients,8871 (61.6%) received neoadjuvant treatment. Long-course chemo/radiotherapy was the most used approach (79.9%), followed by short-course radiotherapy ± chemotherapy (7.6%). The use of neoadjuvant treatment for cancer of the upper third (15-11 cm) increased over time (31.5%vs 34.5%vs 38.6%,p = 0.0018). The complete regression rate slightly increased over time (15.6% vs 16% vs 18.5%; p = 0.0093); the proportion of patients with involved circumferential resection margins (CRM) went down from 8.2% to 7.3%and 5.5% (p = 0.0004). Neoadjuvant treatment significantly decreased positive CRM in lower third tumors (OR 0.71, 0.59-0.87, Cochrane-Mantel-Haenszel P = 0.0008). Most ypN0 patients also received adjuvant therapy. In MR-defined stage III patients, preoperative treatment was associated with significantly longer local-recurrence-free survival (p < 0.0001), and cancer-specific survival (p < 0.0001). The survival benefit was smaller in upper third cancers.
There was an increasing trend and a potential overuse of neoadjuvant treatment in cancer of the upper rectum. Most ypN0 patients received postoperative treatment. Involvement of CRM in lower third tumors was reduced after neoadjuvant treatment. Stage III and MRcN + benefited the most.
术前治疗和充分的手术可以提高直肠癌的局部控制率。然而，新辅助治疗的方式和适应证可能存在争议。本研究的目的是评估纳入西班牙外科医生协会直肠癌登记处的直肠癌患者的术前治疗和结局趋势。
这是一项符合 STROBE 标准的前瞻性数据库回顾性分析。纳入所有接受根治性手术的直肠癌患者。分析比较了三个时间框架内新辅助/辅助治疗的应用：I）2006-2009 年；II）2010-2013 年；III）2014-2017 年。对时间框架 I-II 内的 3 年生存率进行生存分析。
在 14391 名患者中，8871 名（61.6%）接受了新辅助治疗。长程化疗/放疗是最常用的方法（79.9%），其次是短程放疗±化疗（7.6%）。上三分之一（15-11cm）的直肠癌患者接受新辅助治疗的比例随时间增加（31.5%比 34.5%比 38.6%，p=0.0018）。完全缓解率略有增加（15.6%比 16%比 18.5%；p=0.0093）；累及环周切缘（CRM）的患者比例从 8.2%降至 7.3%和 5.5%（p=0.0004）。新辅助治疗显著降低了低位直肠癌的阳性 CRM（OR 0.71，0.59-0.87，Cochrane-Mantel-Haenszel P=0.0008）。大多数 ypN0 患者也接受了辅助治疗。在 MR 定义的 III 期患者中，术前治疗与局部无复发生存（p<0.0001）和癌症特异性生存（p<0.0001）显著相关。上三分之一癌症的生存获益较小。
直肠癌上三分之一的新辅助治疗呈上升趋势且有潜在过度应用。大多数 ypN0 患者接受了术后治疗。新辅助治疗后，低位直肠癌 CRM 受累减少。III 期和 MRcN+患者获益最大。
