Department of Molecular Medicine and Surgery, Karolinska Institutet and Division of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet and Division of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2024 Dec;50(12):108673. doi: 10.1016/j.ejso.2024.108673. Epub 2024 Sep 6.
The aim of this study was to compare relative survival in non-metastatic rectal cancer clinically staged as T3-T4 requiring beyond total mesorectal excision (TME) to that after standard TME.
This population-based study included all patients operated with anterior resection, abdominoperineal excision or Hartmann's procedure for non-metastatic rectal cancer clinically staged as T3-T4 in Sweden between 2009 and 2018. Relative survival was analysed in relation to surgery beyond TME (bTME), which was subcategorized as bTME- and bTME + to account for extent of resection. In all survival analyses, follow-up started at 90 days after surgery. Based on a causal model defined a priori excess mortality rate ratios (EMRR) were estimated using Poisson regression.
Of 8272 included patients 1220 (14.7 %) were operated bTME. In a model adjusted for age and sex bTME was associated with higher excess mortality compared to standard TME (EMRR: 1.76, 95%CI:1.52-2.04). This association persisted after additional adjustment for tumour characteristics, neoadjuvant therapy and hospital volume (EMRR: 1.32, 95%CI:1.11-1.56) and was mainly attributable to restricted relative survival after bTME- (EMRR: 1.42, 95%CI:1.18-1.72) as EMRR after bTME+ was 1.07 (95%CI:0.80-1.44).
This national population-based study showed inferior relative survival after bTME compared to standard TME in non-metastasized rectal cancer cT3-cT4. Unexpectedly this difference was mainly seen after bTME of limited extent.
本研究旨在比较临床分期为 T3-T4 的非转移性直肠癌患者在接受超出全直肠系膜切除（TME）范围的治疗与接受标准 TME 治疗后的相对生存率。
本基于人群的研究纳入了 2009 年至 2018 年期间在瑞典接受直肠前切除术、腹会阴切除术或 Hartmann 手术治疗临床分期为 T3-T4 的非转移性直肠癌患者。相对生存率与超出 TME 的手术（bTME）相关，bTME 进一步分为 bTME-和 bTME+，以反映切除范围。在所有生存分析中，随访从手术后 90 天开始。根据事先定义的因果模型，使用泊松回归估计超额死亡率比（EMRR）。
在纳入的 8272 例患者中，有 1220 例（14.7%）接受了 bTME 手术。在调整年龄和性别后，bTME 与标准 TME 相比，死亡风险更高（EMRR：1.76，95%CI：1.52-2.04）。这种关联在进一步调整肿瘤特征、新辅助治疗和医院规模后仍然存在（EMRR：1.32，95%CI：1.11-1.56），并且主要归因于 bTME 后的相对生存率受限（EMRR：1.42，95%CI：1.18-1.72），因为 bTME+后的 EMRR 为 1.07（95%CI：0.80-1.44）。
这项全国性基于人群的研究表明，与标准 TME 相比，非转移性直肠腺癌 cT3-cT4 患者接受 bTME 后的相对生存率较低。出乎意料的是，这种差异主要见于 bTME 切除范围有限的情况下。
