新辅助治疗后T4期低位直肠癌的腹会阴联合切除术——结果是否可接受？
Abdominoperineal Resection for T4 Low Rectal Cancer After Neoadjuvant Therapy-Are the Outcomes Acceptable?
作者信息
Ballal Devesh S, Raj Prudvi, Janesh M, Kazi Mufaddal, Desouza Ashwin, Saklani Avanish P
机构信息
Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL USA.
Division of Colo-Rectal and Peritoneal Surface Oncology, Department of Surgical Oncology, Tata Memorial Hospital, Dr E. Borges Marg, Parel, Mumbai 400012 India.
出版信息
Indian J Surg Oncol. 2024 Dec;15(4):612-618. doi: 10.1007/s13193-024-02028-3. Epub 2024 Jul 19.
INTRODUCTION
There is no clear consensus on using the response MRI as opposed to the pretreatment MRI for surgical planning in cT4 low rectal cancer. The objective of this study is to determine the safety of using response MRI in surgical planning for T4 rectal cancer.
METHODS
This study is a retrospective review of a prospectively maintained database of abdominoperineal resections conducted at a single tertiary cancer center. Patients undergoing an abdominoperineal resection were divided into 2 groups: group A (clinical T3, mesorectal fascia positive) and group B (clinical T4), and propensity matching was used to account for uneven distribution of baseline characteristics. Primary outcome was the rate of pathological circumferential resection margin positivity. Secondary outcomes were survival outcomes and recurrence patterns.
RESULTS
There were 237 patients in group A and 127 in group B, in the unmatched cohort, with a significantly higher number of females (43.3% vs. 28.7%, = 0.005) and anterior circumferential resection margin positivity (68.5% vs. 49%, < 0.001), with a lower number of patients receiving neoadjuvant chemotherapy in group B (38.6% vs. 49.8%, = 0.041). After propensity matching baseline characters were comparable. There was a higher percentage of extended-total mesorectal excisions in group B (58.5% vs. 40.5%, = 0.004). The rate of pathological circumferential positivity was comparable in both groups (20/168 in group A {11.9%} vs. 13/107 in group B {12.1%}, = 0.951) with no impact of group on circumferential resection margin positivity on univariate (OR 1.023, = 0.951) or multivariate regression (OR 0.993, = 0.987). Both the DFS (median DFS 39 months vs. 54 months, = 0.970) and OS (3-year OS 72% vs. 67%, = 0.798) were comparable between both groups.
CONCLUSION
For T4 low rectal cancers, post-treatment MRI can be used for surgical planning without any detriment in pathological or long-term oncological outcomes.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s13193-024-02028-3.
引言
对于cT4期低位直肠癌的手术规划，使用反应性磁共振成像（MRI）而非治疗前MRI尚无明确共识。本研究的目的是确定在T4期直肠癌手术规划中使用反应性MRI的安全性。
方法
本研究是对在单一三级癌症中心前瞻性维护的腹会阴联合切除术数据库进行的回顾性分析。接受腹会阴联合切除术的患者分为两组：A组（临床T3期，直肠系膜筋膜阳性）和B组（临床T4期），并采用倾向匹配法来处理基线特征分布不均的问题。主要结局是病理环周切缘阳性率。次要结局是生存结局和复发模式。
结果
在未匹配队列中，A组有237例患者，B组有127例患者，B组女性患者数量显著更多（43.3%对28.7%，P = 0.005），前环周切缘阳性率更高（68.5%对49%，P < 0.001），B组接受新辅助化疗的患者数量更少（38.6%对49.8%，P = 0.041）。倾向匹配后，基线特征具有可比性。B组扩大全直肠系膜切除术的比例更高（58.5%对40.5%，P = 0.004）。两组的病理环周阳性率相当（A组168例中有20例{11.9%}，B组107例中有13例{12.1%}，P = 0.951），单因素分析（OR 1.023，P = 0.951）或多因素回归分析（OR 0.993，P = 0.987）中，分组对环周切缘阳性率均无影响。两组的无病生存期（DFS，中位DFS 39个月对54个月，P = 0.970）和总生存期（OS，3年OS 72%对67%，P = 0.798）均相当。
结论
对于T4期低位直肠癌，治疗后MRI可用于手术规划，且对病理或长期肿瘤学结局无任何不利影响。
补充信息
在线版本包含可在10.1007/s13193-024-02028-3获取的补充材料。
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