Mülküt Fırat, Ofluoğlu Cem Batuhan, Başdoğan Mustafa Kağan, Aydın İsa Caner, Doğan Akif, Subaşı İsmail Ege
Department of General Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, 34785 Istanbul, Turkey.
Department of Gastrointestinal Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, University of Health Sciences, 34785 Istanbul, Turkey.
Curr Oncol. 2025 Apr 12;32(4):227. doi: 10.3390/curroncol32040227.
This study aimed to compare the clinical, pathological, and biochemical characteristics of upper rectal cancer (URC) and mid-lower rectal cancer (MLRC) in stage II and III non-metastatic rectal cancer and to identify distinct prognostic factors influencing survival and recurrence. This retrospective cohort study included 100 patients with stage II and III non-metastatic rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy (nCRT) followed by curative-intent surgery between 2021 and 2024. Patients were categorized into URC (n = 53) and MLRC (n = 47) groups. Parameters analyzed included demographic factors, ASA score, surgical characteristics, pathological features (tumor stage, lymph node involvement, lymphovascular invasion (LVI), perineural invasion (PNI), tumor budding, tumor regression grade (TRG)), and biochemical markers (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), white blood cell (WBC) count, neutrophil count, platelet count (PLT), and C-reactive protein (CRP)). One-year overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier survival curves, and Cox regression models identified independent prognostic factors. Preoperative CEA levels were higher in MLRC ( = 0.05), whereas WBC count ( = 0.01), neutrophil count ( = 0.02), PLT ( = 0.01), and CRP levels ( = 0.01) were higher in URC. Pathological analysis revealed higher LVI ( = 0.04), PNI ( = 0.04), and tumor budding ( = 0.03) in MLRC. At one-year follow-up, OS rates were 82.1% (URC) vs. 80.3% (MLRC) ( = 0.85), and DFS rates were 78.6% (URC) vs. 73.4% (MLRC) ( = 0.72). Multivariate Cox regression analysis identified age (HR: 1.04, = 0.03), ASA score (HR: 1.22, = 0.01), CRP (HR: 1.18, < 0.001), preoperative CEA (HR: 1.12, = 0.02), preoperative CA19-9 (HR: 1.09, = 0.03), LVI (HR: 1.42, < 0.001), PNI (HR: 1.35, = 0.02), and tumor budding (HR: 1.28, = 0.03) as independent prognostic factors for OS. Similar trends were observed for DFS, with T stage (HR: 1.35, = 0.01) and tumor size (HR: 1.22, = 0.01) also being found significant. Inflammatory markers, tumor burden indicators (LVI, PNI, budding, tumor size, T stage), and preoperative CEA/CA19-9 were identified as significant predictors, suggesting a risk-adapted approach to rectal cancer treatment.
本研究旨在比较Ⅱ期和Ⅲ期非转移性直肠癌中高位直肠癌（URC）和中低位直肠癌（MLRC）的临床、病理及生化特征，并确定影响生存和复发的不同预后因素。这项回顾性队列研究纳入了100例Ⅱ期和Ⅲ期非转移性直肠腺癌患者，这些患者在2021年至2024年间接受了新辅助放化疗（nCRT），随后进行了根治性手术。患者被分为URC组（n = 53）和MLRC组（n = 47）。分析的参数包括人口统计学因素、美国麻醉医师协会（ASA）评分、手术特征、病理特征（肿瘤分期、淋巴结受累情况、淋巴管浸润（LVI）、神经周围浸润（PNI）、肿瘤芽生、肿瘤退缩分级（TRG））以及生化标志物（癌胚抗原（CEA）、糖类抗原19-9（CA19-9）、白细胞（WBC）计数、中性粒细胞计数、血小板计数（PLT）和C反应蛋白（CRP））。使用Kaplan-Meier生存曲线分析1年总生存（OS）和无病生存（DFS）情况，并通过Cox回归模型确定独立预后因素。MLRC患者术前CEA水平较高（P = 0.05），而URC患者的WBC计数（P = 0.01）、中性粒细胞计数（P = 0.02）、PLT（P = 0.01）和CRP水平（P = 0.01）较高。病理分析显示MLRC的LVI（P = 0.04）、PNI（P = 0.04）和肿瘤芽生（P = 0.03）较高。在1年随访时，OS率分别为82.1%（URC）和80.3%（MLRC）（P = 0.85），DFS率分别为78.6%（URC）和73.4%（MLRC）（P = 0.72）。多因素Cox回归分析确定年龄（HR：
1.04，P = 0.03）、ASA评分（HR：1.22，P = 0.01）、CRP（HR：1.18，P < 0.001）、术前CEA（HR：1.12，P = 0.02）、术前CA19-9（HR：1.09，P = 0.03）、LVI（HR：1.42，P < 0.001）、PNI（HR：1.35，P = 0.02）和肿瘤芽生（HR：1.28，P = 0.03）为OS的独立预后因素。DFS也观察到类似趋势，T分期（HR：1.35，P = 0.01）和肿瘤大小（HR：1.22，P = 0.01）也具有显著性。炎症标志物、肿瘤负荷指标（LVI、PNI、芽生、肿瘤大小、T分期）以及术前CEA/CA19-9被确定为显著预测因素，提示直肠癌治疗应采取风险适应性方法。
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