Kim Seijong, Huh Jung Wook, Lee Woo Yong, Yun Seong Hyeon, Kim Hee Cheol, Cho Yong Beom, Park Yoon Ah, Shin Jung Kyong
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2022 Mar 23;12:767838. doi: 10.3389/fonc.2022.767838. eCollection 2022.
The oncologic outcome of concurrent chemoradiotherapy (CCRT) after local excision in patients with high-risk early rectal cancer as compared with radical operation has not been reported. The aim of this study is to compare the oncologic outcome between radical operation and adjuvant CCRT after local excision for high-risk early rectal cancer.
From January 2005 to December 2015, 266 patients diagnosed with early rectal cancer and treated with local excision who showed high-risk characteristics were retrospectively analyzed. Propensity score matching was applied in a ratio of 1:4, comparing the CCRT/radiotherapy (RT) (n = 34) and radical operation (n = 91) groups. Univariate and multivariate analyses were performed to identify prognostic factors for survival.
The median follow-up period was 112 months. The 5-year disease-free survival rate and the 5-year overall survival of the radical operation group were significantly higher than those of the CCRT/RT group after propensity score matching (96.7% vs. 70.6%, 0.001; 100% vs. 91.2%, = 0.005, respectively). In a multivariate analysis, salvage therapy type and preoperative carcinoembryonic antigen (CEA) were prognostic factors for 5-year disease-free survival (0.001 and = 0.021, respectively). The type of salvage therapy, the preoperative CEA, and the pT were prognostic factors for 5-year overall survival ( = 0.009, = 0.024, and = 0.046, respectively).
Patients who undergo radical operations after local excision with a high-risk early rectal cancer had better survival than those treated with adjuvant CCRT/RT. Therefore, radical surgery may be recommended to high-risk early rectal cancer patients who have undergone local excision for more favorable oncologic outcomes.
高危早期直肠癌患者局部切除术后同步放化疗（CCRT）与根治性手术相比的肿瘤学结局尚未见报道。本研究旨在比较高危早期直肠癌局部切除术后根治性手术与辅助CCRT的肿瘤学结局。
回顾性分析2005年1月至2015年12月期间266例经诊断为早期直肠癌并接受局部切除且具有高危特征的患者。采用倾向评分匹配法，按1:4的比例，比较CCRT/放疗（RT）组（n = 34）和根治性手术组（n = 91）。进行单因素和多因素分析以确定生存的预后因素。
中位随访期为112个月。倾向评分匹配后，根治性手术组的5年无病生存率和5年总生存率显著高于CCRT/RT组（分别为96.7%对70.6%，P = 0.001；100%对91.2%，P = 0.005）。多因素分析中，挽救治疗类型和术前癌胚抗原（CEA）是5年无病生存的预后因素（分别为P = 0.001和P = 0.021）。挽救治疗类型、术前CEA和pT是5年总生存的预后因素（分别为P = 0.009、P = 0.024和P = 0.046）。
高危早期直肠癌局部切除术后接受根治性手术的患者比接受辅助CCRT/RT治疗的患者生存更好。因此，对于接受局部切除的高危早期直肠癌患者，可能推荐行根治性手术以获得更有利的肿瘤学结局。
