Division of Colon and Rectal Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka Pref., 411-8777, Japan.
Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan.
Langenbecks Arch Surg. 2023 Apr 13;408(1):147. doi: 10.1007/s00423-023-02888-3.
The mesorectal fat area (MFA) at the tip of the ischial spines on magnetic resonance imaging has been used to characterize mesorectal morphology. Recent studies reported that a larger MFA correlated with difficulties in rectal cancer surgery. However, the relationship between MFA and rectal cancer prognosis remains unclear. This study evaluated the impact of MFA on recurrence following robotic total mesorectal excision (TME) for rectal cancer.
Patients who underwent robotic TME for lower rectal cancer from December 2011 to December 2016 were enrolled. Cox regression analysis was performed to determine variables associated with relapse-free survival (RFS). Patients were divided into groups based on MFA, and RFS was compared.
Of 230 patients, 173 (75.3%) were male. The median age was 63 years, and median MFA was 19.7 cm. In multivariate analysis, smaller MFA (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.88-0.97; p < 0.01), p/yp stage II (HR, 3.81; 95% CI, 1.40-10.35; p < 0.01), and p/yp stage III (HR, 5.35; 95% CI, 1.88-15.27; p < 0.01) were independently associated with worse RFS. Sex, body mass index, and visceral fat area were not correlated with RFS. In the median follow-up period of 60.8 months, patients with MFA < 19.7 cm had a significantly lower 5-year RFS rate (72.7%) than those with MFA ≥ 19.7 cm (85.0%).
Smaller MFA was associated with worse RFS in patients undergoing robotic TME for lower rectal cancer. MFA is considered to be a prognostic factor in rectal cancer.
坐骨棘尖端的直肠系膜脂肪区（MFA）在磁共振成像中用于描述直肠系膜形态。最近的研究报告称，更大的 MFA 与直肠癌手术难度增加有关。然而，MFA 与直肠癌预后之间的关系尚不清楚。本研究评估了 MFA 对接受机器人全直肠系膜切除术（TME）治疗低位直肠癌患者复发的影响。
纳入 2011 年 12 月至 2016 年 12 月期间接受机器人 TME 治疗的低位直肠癌患者。采用 Cox 回归分析确定与无复发生存（RFS）相关的变量。根据 MFA 将患者分为不同组，并比较 RFS。
在 230 名患者中，173 名（75.3%）为男性。中位年龄为 63 岁，中位 MFA 为 19.7cm。多变量分析显示，较小的 MFA（风险比[HR]，0.93；95%置信区间[CI]，0.88-0.97；p<0.01）、yp 期 II 期（HR，3.81；95% CI，1.40-10.35；p<0.01）和 yp 期 III 期（HR，5.35；95% CI，1.88-15.27；p<0.01）与较差的 RFS 独立相关。性别、体重指数和内脏脂肪面积与 RFS 无关。在中位随访 60.8 个月期间，MFA<19.7cm 的患者 5 年 RFS 率（72.7%）明显低于 MFA≥19.7cm 的患者（85.0%）。
在接受机器人 TME 治疗低位直肠癌的患者中，较小的 MFA 与较差的 RFS 相关。MFA 被认为是直肠癌的预后因素。
