Mariathasan Anthony B, Boye Kjetil, Dueland Svein, Flatmark Kjersti, Larsen Stein G
Department of Gastroenterological Surgery, Section for Surgical Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway; Faculty of Medicine, University of Oslo, Norway.
Department of Oncology, Norwegian Radium Hospital, Oslo University Hospital, Norway; Department of Tumour Biology, Institute for Cancer Research, Norwegian Radium Hospital, Oslo University Hospital, Norway.
Eur J Surg Oncol. 2021 Sep;47(9):2377-2383. doi: 10.1016/j.ejso.2021.04.023. Epub 2021 Apr 27.
The main cause of mortality in locally advanced rectal cancer (LARC) is metastatic progression. The aim of the present study was to describe frequency, pattern and outcome of metastatic disease in a cohort of LARC patients after curative resection.
This was a single-centre cohort study of 628 LARC cases after neoadjuvant chemoradiotherapy/radiotherapy (CRT/RT) and surgery. Data, including the first site of metastasis, was registered in an institutional database linked to the National Cancer Registry.
Metastases were diagnosed in 270 patients (43.0%) with liver and lungs as the first site in 113 and 96 cases, respectively. Involved resection margins, high tumour stage and poor response to CRT/RT were associated with metastasis development and inferior overall survival (OS). Metastasectomy was performed in 76 (67.3%) patients with liver metastases and 28 (29.2%) patients with lung metastases. Five-year OS was 89% in patients without metastases and 32% in metastatic cases. In patients selected for metastasectomy, 5-year OS was 69% and 53% for lung and liver metastases, respectively. Corresponding numbers without metastasectomy were 12% and 0%.
In this large LARC cohort undergoing curatively intended treatment, liver and lung metastases occurred at similar frequencies. Liver as the first metastatic site was associated with inferior long-term outcome, while selection for metastasectomy was associated with better OS, with more than half of the resected patients being alive five years after LARC surgery. Our results show that the presence of resectable metastatic disease at diagnosis should not exclude a curative therapeutic approach in LARC.
局部晚期直肠癌（LARC）患者死亡的主要原因是转移进展。本研究的目的是描述一组LARC患者根治性切除术后转移疾病的发生率、模式和结局。
这是一项对628例接受新辅助放化疗/放疗（CRT/RT）及手术的LARC病例进行的单中心队列研究。包括转移的首发部位在内的数据被记录在与国家癌症登记处相关联的机构数据库中。
270例患者（43.0%）被诊断发生转移，其中肝脏和肺分别为113例和96例患者转移的首发部位。切缘受累、肿瘤分期高以及对CRT/RT反应差与转移的发生及总体生存期（OS）较差相关。76例（67.3%）肝转移患者和28例（29.2%）肺转移患者接受了转移灶切除术。无转移患者的5年OS为89%，转移患者为32%。在选择进行转移灶切除术的患者中，肺转移和肝转移患者术后5年OS分别为69%和53%。未进行转移灶切除术的相应比例分别为12%和0%。
在这个接受根治性治疗意向的大型LARC队列中，肝转移和肺转移的发生率相似。以肝脏作为首个转移部位与较差的长期结局相关，而选择进行转移灶切除术与更好的OS相关，超过一半接受切除的患者在LARC手术后5年仍存活。我们的结果表明，诊断时存在可切除的转移性疾病不应排除LARC的根治性治疗方法。
