显微镜下切缘阳性（≤1毫米）对新辅助放化疗治疗的直肠癌疾病复发的影响。
Impact of Microscopically Positive (≤1 mm) Distal Margins on Disease Recurrence in Rectal Cancer Treated by Neoadjuvant Chemoradiotherapy.
作者信息
Sorrentino Luca, Sileo Annaclara, Daveri Elena, Battaglia Luigi, Guaglio Marcello, Centonze Giovanni, Sabella Giovanna, Patti Filippo, Villa Sergio, Milione Massimo, Belli Filiberto, Cosimelli Maurizio
机构信息
Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
Immunotherapy of Human Tumors Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy.
出版信息
Cancers (Basel). 2023 Mar 17;15(6):1828. doi: 10.3390/cancers15061828.
BACKGROUND
The adequate distal resection margin is still controversial in rectal cancer treated by neoadjuvant chemoradiotherapy (nCRT). The aim of this study was to assess the impact of a distal margin of ≤1 mm on locoregional recurrence-free survival (LRRFS).
METHODS
Among 255 patients treated with nCRT and surgery at the National Cancer Institute of Milan, 83 (32.5%) had a distal margin of ≤1 mm and 172 (67.5%) had a distal margin of >1 mm. Survival analyses were performed to assess the impact of distal margin on 5-year LRRFS, as well as Cox survival analysis. The role of distal margin on survival was analyzed according to different tumor regression grades (TRGs).
RESULTS
The overall 5-year LRRFS rate was 77.6% with a distal margin of ≤1 mm vs. 88.3% with a distal margin of >1 mm (Log-rank = 0.09). Only stage ypT4 was an independent predictor of worse LRRFS (HR 15.14, = 0.026). The 5-year LRRFS was significantly lower in TRG3-5 patients with a distal margin of ≤1 mm compared to those with a distal margin of >1 mm (68.5% vs. 84.2%, = 0.027), while no difference was observed in case of TRG1-2 ( = 0.77).
CONCLUSIONS
Low-responder rectal cancers after nCRT still require a distal margin of >1 mm to reduce the high likelihood of local relapse.
背景
在接受新辅助放化疗（nCRT）治疗的直肠癌中，足够的远切缘仍存在争议。本研究的目的是评估≤1mm的远切缘对局部区域无复发生存率（LRRFS）的影响。
方法
在米兰国家癌症研究所接受nCRT和手术治疗的255例患者中，83例（32.5%）远切缘≤1mm，172例（67.5%）远切缘>1mm。进行生存分析以评估远切缘对5年LRRFS的影响，以及Cox生存分析。根据不同的肿瘤退缩分级（TRG）分析远切缘对生存的作用。
结果
远切缘≤1mm的患者5年总体LRRFS率为77.6%，而远切缘>1mm的患者为88.3%（对数秩检验=0.09）。只有ypT4期是LRRFS较差的独立预测因素（风险比15.14，P=0.026）。与远切缘>1mm的TRG1-2患者相比，远切缘≤1mm的TRG3-5患者5年LRRFS显著更低（68.5%对84.2%，P=0.027），而TRG1-2患者中未观察到差异（P=0.77）。
结论
nCRT后反应较低的直肠癌仍需要>1mm的远切缘以降低局部复发的高可能性。
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