Jiang Dan, Fan Xiaona, Chen Kaige, Li Hengzhen, Dai Yisheng, Sun Ning, Li Zhiwei
Department of Gastrointestinal Oncology, Harbin Medical University Cancer Hospital, Harbin, China.
J Gastrointest Oncol. 2023 Apr 29;14(2):963-979. doi: 10.21037/jgo-23-222. Epub 2023 Apr 25.
To evaluate the effect of magnetic resonance imaging (MRI)-detected extramural vascular invasion (mrEMVI) and tumor deposits (TDs) on distant metastasis and long-term survival after surgery for stage III rectal cancer based on the relationship between the bottom of the tumor and peritoneal reflection.
A retrospective study was performed on 694 patients who underwent radical resection for rectal cancer at the Harbin Medical University Tumor Hospital from October 2016 to October 2021. According to the surgical records, a new group was established based on the relationship between the lower end of the tumor and peritoneal reflection. On the peritoneal reflection group: the tumors are all located on the peritoneal reflection. Across the peritoneal reflection group: the tumors recurred across the peritoneal reflection. Under the peritoneal reflection group: the tumors are all located under the peritoneal reflection. We evaluated the effects of mrEMVI and TDs on postoperative distant metastasis and long-term survival of stage III rectal cancer by combining mrEMVI with TDs.
In the whole study population, neoadjuvant therapy (P=0.003) was negatively correlated with distant metastasis after rectal cancer surgery. Also, mesorectal fascia (MRF) (P=0.024), postoperative distant metastasis (P<0.001), and TDs (P<0.001) were independent risk factors for long-term survival after rectal cancer surgery. Lymph node metastasis (P<0.001) and neoadjuvant therapy (P=0.023) were independent risk factors for the presence or absence of TDs of rectal cancer. In the non-neoassisted subgroup, postoperative distant metastasis (P<0.001) was considered to be an independent risk factor for long-term survival after rectal cancer surgery.
In the under the peritoneal reflection group, the combination of mrEMVI and TDs seems to play a certain guiding role in predicting distant metastasis and long-term survival after rectal cancer surgery.
基于肿瘤底部与腹膜反折的关系，评估磁共振成像（MRI）检测到的壁外血管侵犯（mrEMVI）和肿瘤结节（TDs）对Ⅲ期直肠癌术后远处转移和长期生存的影响。
对2016年10月至2021年10月在哈尔滨医科大学肿瘤医院接受直肠癌根治性切除术的694例患者进行回顾性研究。根据手术记录，基于肿瘤下端与腹膜反折的关系建立新的分组。腹膜反折组：肿瘤均位于腹膜反折处。跨腹膜反折组：肿瘤跨越腹膜反折复发。腹膜反折以下组：肿瘤均位于腹膜反折以下。我们通过将mrEMVI与TDs相结合，评估mrEMVI和TDs对Ⅲ期直肠癌术后远处转移和长期生存的影响。
在整个研究人群中，新辅助治疗（P = 0.003）与直肠癌术后远处转移呈负相关。此外，直肠系膜筋膜（MRF）（P = 0.024）、术后远处转移（P < 0.001）和TDs（P < 0.001）是直肠癌术后长期生存的独立危险因素。淋巴结转移（P < 0.001）和新辅助治疗（P = 0.023）是直肠癌TDs存在与否的独立危险因素。在非新辅助亚组中，术后远处转移（P < 0.001）被认为是直肠癌术后长期生存的独立危险因素。
在腹膜反折以下组中，mrEMVI与TDs的联合似乎对预测直肠癌术后远处转移和长期生存具有一定的指导作用。
