Uda Shuji, Mukai Masaya, Kishima Kyoko, Yokoyama Daiki, Hasegawa Sayuri, Koike Takuya, Tajima Takayuki, Nomura Eiji, Tomita Kousuke, Matsumoto Tomohiro, Hasebe Terumitsu, Makuuchi Hiroyasu
Department of Digestive Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan.
Department of Surgery, Tokai University Tokyo Hospital, Shibuya, Tokyo 151-0053, Japan.
Mol Clin Oncol. 2021 Feb;14(2):33. doi: 10.3892/mco.2020.2195. Epub 2020 Dec 18.
The present study investigated the association between the mode of tumor recurrence and prognosis in 123 patients with clinical stage II/III rectal cancer. In the past 10 years, patients received systemic chemotherapy following radical (R0, with no macroscopic residual tumor lesions) resection using total or tumor-specific mesorectal excision. Patients with rectosigmoid cancer and T4 + chemoradiation therapy were excluded from the present study. The 5-year relapse-free survival rate (5Y-RFS), 5-year overall survival rate (5Y-OS), and associations between early post-operative complications, recurrence mode and prognosis, as well as the 5Y-OS of patients with relapsed cancer, were calculated. The overall 5Y-RFS and 5Y-OS were 71.4 and 83.5%, respectively, and the overall recurrence rate was 22.8% (28/123 patients). Among relapses, remote metastases were observed in 17/123 patients (13.8%): The lung in 8 patients (6.5%), the liver in 5 patients (4.1%) and elsewhere in 4 patients (3.3%). A total of 11 patients (8.9%) had pelvic local recurrence as the first relapse, which was located anterior to the sacrum in 7 patients (5.7%), at the anastomosis site in 2 patients (1.6%), and in the inner pelvis in 2 patients (1.6%). Among relapsed patients, the 5Y-OS was 69.3% in those with distant metastases and 27.3% in those with local relapse (P=0.02; no significant differences in patient demographics). The results indicated that advanced rectal cancer and control of pelvic local recurrence are manageable by R0 resection and postoperative chemotherapy. However, for patients whose initial relapse was pelvic local recurrence, the relapsed tumor initiated a new metastatic cascade to organs, such as the lung and liver, and affected prognosis.
本研究调查了123例临床II/III期直肠癌患者的肿瘤复发模式与预后之间的关联。在过去10年中，患者在使用全直肠系膜切除术或肿瘤特异性直肠系膜切除术进行根治性（R0，无宏观残留肿瘤病灶）切除后接受全身化疗。本研究排除了直肠乙状结肠癌患者和接受了T4 + 放化疗的患者。计算了5年无复发生存率（5Y-RFS）、5年总生存率（5Y-OS），以及术后早期并发症、复发模式与预后之间的关联，还有复发癌患者的5Y-OS。总体5Y-RFS和5Y-OS分别为71.4%和83.5%，总体复发率为22.8%（28/123例患者）。在复发患者中，17/123例患者（13.8%）出现远处转移：8例患者（6.5%）转移至肺部，5例患者（4.1%）转移至肝脏，4例患者（3.3%）转移至其他部位。共有11例患者（8.9%）以盆腔局部复发为首次复发，其中7例患者（5.7%）复发位于骶骨前方，2例患者（1.6%）复发于吻合口部位，2例患者（1.6%）复发于盆腔内部。在复发患者中，远处转移患者的5Y-OS为69.3%，局部复发患者的5Y-OS为27.3%（P = 0.02；患者人口统计学无显著差异）。结果表明，R0切除和术后化疗可控制晚期直肠癌并控制盆腔局部复发。然而，对于初始复发为盆腔局部复发的患者，复发肿瘤引发了新的转移级联至肺和肝等器官，并影响预后。
