Sung Soo-Yoon, Kim Sung Hwan, Jang Hong Seok, Song Jin Ho, Jeong Songmi, Jung Ji-Han, Lee Jong Hoon
Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea.
Department of Radiation Oncology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Korea.
Cancers (Basel). 2022 Aug 25;14(17):4112. doi: 10.3390/cancers14174112.
We assessed the exact role of adjuvant chemotherapy after neoadjuvant chemoradiotherapy (CRT) and surgery in rectal cancer patients with positive surgical margin or perineural invasion (PNI). This multi-institutional study included 1799 patients with rectal cancer at cT3-4N0-2M0 stages. Patients were divided into two groups. The high-risk group had a positive margin and/or perineural invasion. The low-risk group showed no positive margin or PNI. Propensity-score matching analysis was performed, and a total of 928 patients, with 464 in each arm, were evaluated. The high-risk group showed significant differences in overall survival (OS, 73.4% vs. 53.9%, p < 0.01) and recurrence-free survival (RFS, 52.7% vs. 40.9%, p = 0.01) at five years between the adjuvant chemotherapy arm and observation arm. The low-risk group showed no significant differences in 5-year OS (p = 0.61) and RFS (p = 0.75) between the two arms. Multivariate analyses showed that age, pathologic N stage, and adjuvant chemotherapy were significantly correlated with OS and RFS in the high-risk group (all p < 0.05). Adjuvant chemotherapy improved OS and RFS more significantly in rectal cancer patients with positive surgical margin or PNI than in those with negative surgical margin and PNI.
我们评估了新辅助放化疗（CRT）及手术后辅助化疗在手术切缘阳性或存在神经周围侵犯（PNI）的直肠癌患者中的确切作用。这项多机构研究纳入了1799例cT3 - 4N0 - 2M0期的直肠癌患者。患者被分为两组。高危组存在切缘阳性和/或神经周围侵犯。低危组未出现切缘阳性或神经周围侵犯。进行了倾向评分匹配分析，共评估了928例患者，每组464例。高危组中，辅助化疗组与观察组在五年总生存期（OS，73.4%对53.9%，p < 0.01）和无复发生存期（RFS，52.7%对40.9%，p = 0.01）方面存在显著差异。低危组中，两组在5年总生存期（p = 0.61）和无复发生存期（p = 0.75）方面无显著差异。多因素分析显示，高危组中年龄、病理N分期和辅助化疗与总生存期和无复发生存期显著相关（均p < 0.05）。与手术切缘阴性且无神经周围侵犯的直肠癌患者相比，辅助化疗对手术切缘阳性或存在神经周围侵犯的直肠癌患者总生存期和无复发生存期的改善更为显著。
