Division of Colorectal Surgery, Department of Surgery, Biomedical Park Hospital, National Taiwan University Hospital, Hsinchu, Taiwan, Republic of China.
Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taiwan, Taipei, Republic of China.
Int J Colorectal Dis. 2021 Mar;36(3):509-516. doi: 10.1007/s00384-020-03787-5. Epub 2020 Oct 30.
Current guidelines suggest that adjuvant chemotherapy (AC) be administered to all locally advanced (clinically T3-4 or N-positivity) rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT) and radical surgical resection regardless of the final pathological staging (yp staging). This study aimed to evaluate the necessity of AC for ypT0-2N0 rectal cancer.
Patients with ypT0-2N0 rectal cancer, who received nCRT and radical surgical resection, were recruited retrospectively at a university hospital. The main outcome was to evaluate the 5-year overall survival (OS) and disease-free survival (DFS) between ypT0-2N0 rectal cancer patients with AC and those without AC. We also identified potential independent prognostic factors associated with poor outcomes.
One hundred and ten ypT0-2N0 rectal cancer patients (ypT0: n = 6; ypT1: n = 44; ypT2: n = 60) were followed up for a median of 60 months. No significant difference was observed in DFS and 5-year OS between patients with AC and those without AC. The risk of recurrence was associated with the postoperative pathological staging (0% with ypT0, 2.4% with ypT1, and 10% with ypT2). In the multivariate analysis, retrieval of < 12 lymph nodes was an independent favorable prognostic factor, which correlated with a higher OS (HR: 2.263; 95% CI: 1.093-4.687, P = 0.028). Intra-tumor lymphovascular and perineural invasion were poor prognostic markers for shorter DFS (HR: 5.940; 95% CI: 1.150-30.696, P = 0.033).
Postoperative AC is not required for patients with ypT0-2N0 rectal cancer downstaged by nCRT, especially in those without poor prognostic factors.
目前的指南建议，所有接受新辅助放化疗（nCRT）和根治性手术切除的局部进展期（临床 T3-4 或 N 阳性）直肠癌患者，无论最终病理分期（yp 分期）如何，均应接受辅助化疗（AC）。本研究旨在评估 AC 对 ypT0-2N0 直肠癌的必要性。
在一所大学医院，回顾性招募了接受 nCRT 和根治性手术切除的 ypT0-2N0 直肠癌患者。主要结局是评估 ypT0-2N0 直肠癌患者接受 AC 和未接受 AC 的 5 年总生存率（OS）和无病生存率（DFS）。我们还确定了与不良预后相关的潜在独立预后因素。
110 例 ypT0-2N0 直肠癌患者（ypT0：n=6；ypT1：n=44；ypT2：n=60）中位随访 60 个月。接受 AC 和未接受 AC 的患者在 DFS 和 5 年 OS 方面无显著差异。复发风险与术后病理分期相关（ypT0 为 0%，ypT1 为 2.4%，ypT2 为 10%）。在多变量分析中，<12 枚淋巴结的检出是一个独立的有利预后因素，与更高的 OS 相关（HR：2.263；95%CI：1.093-4.687，P=0.028）。肿瘤内淋巴管和神经侵犯是 DFS 较短的不良预后标志物（HR：5.940；95%CI：1.150-30.696，P=0.033）。
nCRT 降期后的 ypT0-2N0 直肠癌患者术后无需接受 AC，特别是无不良预后因素的患者。
