Zhu Zixing, Jiang Dedi, Jiang Yujuan, Quan Jichuan, Zhang Mingguang, Pei Wei, Bi Jianjun, Feng Qiang, Zhou Haitao, Wang Zheng, Zheng Zhaoxu, Liu Qian, Zhao Zhixun, Liang Jianwei
Department of Colorectal Surgery, National Clinical Research Center for Cancer/Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China.
BMC Cancer. 2025 Mar 30;25(1):574. doi: 10.1186/s12885-025-14001-6.
In the context of surgical treatment for rectal cancer, the dentate line is acknowledged as a critical anatomical landmark. However, the prognostic implications of dentate line invasion (DLI) remain elusive and warrant further investigation. This study aims to evaluate and compare the outcomes of patients with rectal cancer who underwent abdominoperineal resection (APR), distinguishing between those with and without DLI.
Between January 2006 and December 2017, this study enrolled 1854 patients with rectal cancer who underwent APR. The cohort was divided into two groups, namely the DLI group (n = 340) and the non-DLI group (n = 1514). The primary endpoints were distant relapse-free survival (DRFS) and local recurrence-free survival (LRFS). Univariate and multivariate analyses were conducted to assess the impact of DLI on DRFS, LRFS, overall survival (OS), and disease-free survival (DFS).
The median follow-up duration for the patients was 92.9 months, with a 5-year OS rate of 92.0% for the entire cohort. Compared to the non-DLI group, patients in the DLI group showed significantly poorer outcomes, with 5-year DRFS at 57.4% vs. 73.9% (P < 0.001), DFS at 51.2% vs. 70.7% (P < 0.001), and LRFS at 71.7% vs. 88.5% (P = 0.018). OS was the only metric that showed no significant difference(89.0% vs. 92.6%, P = 0.064). Multivariate analysis demonstrated that DLI negatively impacted DRFS (hazard ratio HR 1.319, P = 0.029), LRFS (HR 2.059, P < 0.001), and DFS (HR 1.563, P < 0.001) as an independent prognostic factor. Furthermore, distant metastasis occurred more frequently in the DLI group (30.0% vs. 23.1%, P = 0.002), along with a higher rate of locoregional recurrence. (16.8% vs. 8.3%, P < 0.001).
DLI correlates with a heightened likelihood of locoregional recurrence and distant metastasis among rectal cancer patients treated with APR. This association underscores the significance of DLI as a crucial prognostic factor that should be considered when developing clinical management strategies.
在直肠癌的外科治疗背景下，齿状线被认为是一个关键的解剖学标志。然而，齿状线侵犯（DLI）的预后意义仍不明确，值得进一步研究。本研究旨在评估和比较接受腹会阴联合切除术（APR）的直肠癌患者的预后，区分有无DLI的患者。
2006年1月至2017年12月，本研究纳入了1854例行APR的直肠癌患者。该队列分为两组，即DLI组（n = 340）和非DLI组（n = 1514）。主要终点是远处无复发生存期（DRFS）和局部无复发生存期（LRFS）。进行单因素和多因素分析以评估DLI对DRFS、LRFS、总生存期（OS）和无病生存期（DFS）的影响。
患者的中位随访时间为92.9个月，整个队列的5年OS率为92.0%。与非DLI组相比，DLI组患者的预后明显较差，5年DRFS分别为57.4%和73.9%（P < 0.001），DFS分别为51.2%和70.7%（P < 0.001），LRFS分别为71.7%和88.5%（P = 0.018）。OS是唯一无显著差异的指标（89.0%对92.6%，P = 0.064）。多因素分析表明，DLI作为独立的预后因素对DRFS（风险比HR 1.319，P = 0.029）、LRFS（HR 2.059，P < 0.001）和DFS（HR 1.563，P < 0.001）有负面影响。此外，DLI组远处转移更频繁（30.0%对23.1%，P = 0.002），局部区域复发率也更高（16.8%对8.3%，P < 0.001）。
DLI与接受APR治疗的直肠癌患者局部区域复发和远处转移的可能性增加相关。这种关联强调了DLI作为一个关键预后因素的重要性，在制定临床管理策略时应予以考虑。
