Kozu Takumi, Akiyoshi Takashi, Sakamoto Takashi, Yamaguchi Tomohiro, Yamamoto Seiichiro, Okamura Ryosuke, Konishi Tsuyoshi, Umemoto Yoshihisa, Hida Koya, Naitoh Takeshi
Gastroenterological Center, Department of Colorectal Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Rectal Cancer Multidisciplinary Treatment Center Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Ann Gastroenterol Surg. 2024 Aug 19;9(1):128-136. doi: 10.1002/ags3.12849. eCollection 2025 Jan.
Identifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.
Data from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine-Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.
Across the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7-14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index ≥25 kg/m, distance from anal verge ≤4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.
This large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment.
识别局部复发（LR）的危险因素对于优化直肠癌治疗至关重要。在日本，全直肠系膜切除术（TME）和侧方淋巴结清扫术（LLND）是晚期低位直肠癌的标准治疗方法。然而，评估LR危险因素的大规模研究有限。
分析了2010年1月至2011年12月期间在69家医院接受手术治疗的1479例腹膜反折以下临床II/III期低位直肠癌患者的数据。采用Fine-Gray多变量回归模型识别与LR相关的危险因素。建立了两个模型：一个仅使用术前因素，另一个纳入手术和术后因素。
在整个队列中，LR的5年累积发病率为12.3%（95%置信区间，10.7-14.1）。多变量分析将LR与各种术前（体重指数、距肛缘距离、cN分类和组织学亚型）、治疗相关（新辅助治疗和LLND）和术后（pT、pN和手术切缘）危险因素相关联。对于未接受新辅助治疗的患者，有两到三个术前危险因素（体重指数≥25kg/m²、距肛缘距离≤4.0cm、非高/中分化腺癌）时，LR风险高得令人无法接受。未接受LLND治疗的患者LR的5年累积发病率为24.7%，接受LLND治疗的患者为22.9%。
这项大型多中心队列研究在以 upfront TME 为主的情况下识别了一些LR危险因素，为优化直肠癌治疗提供了见解。
