齿状线侵犯是局部晚期低位直肠癌合并肛门括约肌侵犯患者远处无复发生存不良的预测因素。

Dentate line invasion as a predictive factor of poor distant relapse-free survival in locally advanced lower rectal cancer with anal sphincter involvement.

机构信息

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.

Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 3 of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142, People's Republic of China.

出版信息

BMC Cancer. 2022 Nov 19;22(1):1196. doi: 10.1186/s12885-022-10299-8.

DOI:10.1186/s12885-022-10299-8

PMID:36403007

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9675199/

Abstract

BACKGROUND

While an important surgical landmark of the dentate line has been established for locally advanced lower rectal cancer (LALRC), the prognostic significance of dentate line invasion (DLI) has not been well defined. This study aimed to explore the impact of DLI on prognosis in LALRC patients with anal sphincter involvement after neoadjuvant chemoradiotherapy followed by surgery.

METHODS

We analyzed 210 LALRC patients and classified them into DLI group (n = 45) or non-DLI group (n = 165). The exact role of DLI in survival and failure patterns was assessed before and after propensity-score matching(PSM). Finally, 50 patients were matched.

RESULTS

Before matching, patients in the DLI group had poorer 5-year distant relapse-free survival (DRFS) (P < 0.001), disease-free survival (DFS) (P < 0.001), and overall survival (OS) (P = 0.022) than those in the non-DLI group, with the exception of local recurrence-free survival (LRFS) (P = 0.114). After PSM, the 5-year DRFS, DFS, OS, and LRFS were 51.7% vs. 79.8%(P = 0.026), 51.7% vs. 79.8%(P = 0.029), 71.6% vs. 85.4%(P = 0.126), and 85.7% vs. 92.0%(P = 0.253), respectively, between the two groups. DLI was also an independent prognostic factor for poor DRFS with (Hazard ratio [HR] 3.843, P = 0.020) or without matching (HR 2.567, P = 0.001). The DLI group exhibited a higher rate of distant metastasis before (44.4% vs. 19.4%, P < 0.001) and after matching (48.0% vs. 20.0%, P = 0.037) and similar rates of locoregional recurrence before (13.3% vs.7.9%, P = 0.729) and after matching (16.0% vs.12.0%, P = 1.000).

CONCLUSIONS

DLI may portend worse DRFS and distant metastasis in LALRC patients with anal sphincter involvement, and this may be an important variable to guide clinicians.

摘要

背景

虽然齿状线已被确定为局部进展期低位直肠癌（LALRC）的重要手术标志，但齿状线侵犯（DLI）的预后意义尚未明确。本研究旨在探讨新辅助放化疗后手术治疗伴有肛门括约肌受累的 LALRC 患者中 DLI 对预后的影响。

方法

我们分析了 210 例 LALRC 患者，并将其分为 DLI 组（n=45）或非 DLI 组（n=165）。在进行倾向评分匹配（PSM）前后，评估 DLI 在生存和失败模式中的确切作用。最终，50 例患者进行了匹配。

结果

在匹配之前，DLI 组患者的 5 年远处无复发生存率（DRFS）（P<0.001）、无病生存率（DFS）（P<0.001）和总生存率（OS）（P=0.022）均低于非 DLI 组，局部无复发生存率（LRFS）除外（P=0.114）。PSM 后，两组患者的 5 年 DRFS、DFS、OS 和 LRFS 分别为 51.7% vs. 79.8%（P=0.026）、51.7% vs. 79.8%（P=0.029）、71.6% vs. 85.4%（P=0.126）和 85.7% vs. 92.0%（P=0.253）。DLI 也是 DRFS 不良的独立预后因素，有（风险比 [HR] 3.843，P=0.020）或无匹配（HR 2.567，P=0.001）。DLI 组在匹配前后远处转移的发生率均较高（匹配前 44.4% vs. 19.4%，P<0.001；匹配后 48.0% vs. 20.0%，P=0.037），局部复发率相似（匹配前 13.3% vs. 7.9%，P=0.729；匹配后 16.0% vs. 12.0%，P=1.000）。