Zhu Zixing, Wang Chunbing, Jiang Dedi, Zhao Zhixun, Bi Jianjun, Feng Qiang, Pei Wei, Zhou Haitao, Zheng Zhaoxu, Liu Qian, Quan Jichuan, Liang Jianwei
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan South Lane, Chaoyang District, Beijing, 100021, China.
Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Tech Coloproctol. 2025 Apr 9;29(1):99. doi: 10.1007/s10151-025-03114-6.
Randomized controlled trials have revealed that abdominoperineal resection leads to inferior oncological outcomes compared with low anterior resection, especially regarding local recurrence rates (LRRs). While neoadjuvant chemoradiotherapy can lower LRRs, it is linked to potential short- and long-term radiation-induced adverse effects. Consequently, meticulous patient selection for neoadjuvant chemoradiotherapy is imperative to balance benefits and risks.
This research encompassed individuals with rectal cancer (RC) who underwent abdominoperineal resection (APR) from January 2006 to December 2017. The cohort was categorized into two cohorts on the basis of tumor location: the anterior cohort and the nonanterior cohort. Propensity score matching (PSM) was employed to mitigate selection bias, and this resulted in 767 patients in both cohorts. The primary endpoint assessed was survival without local recurrence (LR).
Of the 2025 cases examined, 1806 were deemed eligible for inclusion. In the entire cohort, the incidence of LR was 9.9% (178/1806); the anterior cohort exhibited a higher rate of LR (15.2% versus 5.9%, p < 0.001). Multivariate examination revealed that anterior location was an independent risk factor (IRF) for LR (hazard ratio [HR] = 2.503, p < 0.001). In patients with stage II/III or T3/4, anterior location persisted as a predictor of increased LR. Neoadjuvant chemoradiotherapy for stage II and III tumors diminished the LR rate in anterior tumor locations (p = 0.017) but not in nonanterior locations (p = 0.390).
Anterior tumor location is an IRF for LR in RC patients. Tumor location can serve as a criterion for patient selection in neoadjuvant chemoradiotherapy.
The studies involving human participants were reviewed and approved by the National Cancer Center's Institute Research Medical Ethics Committee (23/180-3922, 11 May 2023). A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
随机对照试验表明，与低位前切除术相比，腹会阴联合切除术导致的肿瘤学结局较差，尤其是在局部复发率（LRR）方面。虽然新辅助放化疗可以降低局部复发率，但它与潜在的短期和长期放疗引起的不良反应有关。因此，必须对新辅助放化疗进行细致的患者选择，以平衡获益和风险。
本研究纳入了2006年1月至2017年12月期间接受腹会阴联合切除术（APR）的直肠癌（RC）患者。根据肿瘤位置将队列分为两个队列：前部队列和非前部队列。采用倾向评分匹配（PSM）来减轻选择偏倚，最终两个队列各有767例患者。评估的主要终点是无局部复发（LR）的生存期。
在检查的2025例病例中，1806例被认为符合纳入标准。在整个队列中，LR的发生率为9.9%（178/1806）；前部队列的LR发生率更高（15.2%对5.9%，p<0.001）。多因素分析显示，前部位置是LR的独立危险因素（IRF）（风险比[HR]=2.503，p<0.001）。在II/III期或T3/4期患者中，前部位置仍然是LR增加的预测因素。II期和III期肿瘤的新辅助放化疗降低了前部肿瘤位置的LR率（p=0.017），但在非前部位置则没有降低（p=0.390）。
前部肿瘤位置是RC患者LR的IRF。肿瘤位置可作为新辅助放化疗患者选择的标准。
涉及人类参与者的研究经国家癌症中心研究所研究医学伦理委员会审查并批准（23/180-3922，2023年5月11日）。如有要求，本杂志主编可查阅书面同意书副本。
