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直肠癌中直肠系膜分级与肿瘤学结局的关联：一项系统评价与Meta分析

Association Between Mesorectal Grade and Oncologic Outcomes in Rectal Cancer: A Systematic Review and Meta-Analysis.

作者信息

Rogers Peter, Dourado Justin, Emile Sameh Hany, Wignakumar Anjelli, Delgado Zachary, Aeschbacher Pauline, Garoufalia Zoe, Strassmann Victor, Wexner Steven D

机构信息

Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA.

Florida Atlantic University, College of Medicine, Department of General Surgery, Boca Raton, Florida, USA.

出版信息

J Surg Oncol. 2025 Sep;132(3):437-446. doi: 10.1002/jso.70038. Epub 2025 Jul 11.

DOI:10.1002/jso.70038
PMID:40643076
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12455534/
Abstract

We aimed to clarify the impact of TME grading on recurrence and survival. PubMed and Scopus were searched. The main outcome measures were local and distant recurrence and overall survival. Ten studies (2002-2023) were analyzed. Patients with incomplete TME exhibited lower overall survival (HR 0.75, p = 0.044) and higher local (RR 3.09, p = 0.001) and distant (RR 1.44, p = 0.005) recurrence rates compared to complete/near-complete TME. Complete and near-complete TME had similar risk of local recurrence, distant metastasis, and overall survival. This meta-analysis supports the crucial role of TME in rectal cancer outcomes.

摘要

我们旨在阐明全直肠系膜切除术（TME）分级对复发和生存的影响。检索了PubMed和Scopus数据库。主要结局指标为局部和远处复发以及总生存期。分析了10项研究（2002年至2023年）。与完全/接近完全TME相比，TME不完全的患者总生存期较低（风险比[HR]为0.75，p = 0.044），局部复发率（相对危险度[RR]为3.09，p = 0.001）和远处复发率（RR为1.44，p = 0.005）较高。完全和接近完全TME在局部复发、远处转移和总生存期方面的风险相似。这项荟萃分析支持了TME在直肠癌预后中的关键作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e38d/12455534/9791f23d6cda/JSO-132-437-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e38d/12455534/818c25c1cef0/JSO-132-437-g005.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e38d/12455534/9791f23d6cda/JSO-132-437-g002.jpg

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本文引用的文献

1
Discordance in Total Mesorectal Excision Specimen Grading in a Prospective Phase 2 Multicenter Rectal Cancer Trial: Are We Overestimating the Quality of Our Resections?在一项前瞻性 2 期多中心直肠癌试验中，全直肠系膜切除标本分级存在不一致性：我们是否高估了我们的切除质量？
Ann Surg. 2023 Sep 1;278(3):452-463. doi: 10.1097/SLA.0000000000005948. Epub 2023 Jul 17.
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Comparison of surgeon and pathologist total mesorectal excision grade after rectal cancer resection: A single institution analysis.直肠癌切除术后外科医生与病理学家的直肠系膜全切除分级比较：单机构分析
J Surg Oncol. 2023 May;127(6):983-990. doi: 10.1002/jso.27214. Epub 2023 Feb 15.
3
Does Completeness of the Mesorectal Excision Still Correlate With Local Recurrence?
直肠系膜完整切除与局部复发是否仍相关？
Dis Colon Rectum. 2023 Jul 1;66(7):898-904. doi: 10.1097/DCR.0000000000002551. Epub 2023 Jan 4.
4
Total Neoadjuvant Therapy vs Standard Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Meta-analysis.局部晚期直肠癌的新辅助治疗与标准治疗的比较：系统评价和荟萃分析。
JAMA Netw Open. 2020 Dec 1;3(12):e2030097. doi: 10.1001/jamanetworkopen.2020.30097.
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Development of the 'PREDICT' score through a systematic review and meta-analysis of the predictive parameters for locoregional recurrence after total mesorectal excision.通过对全直肠系膜切除术后局部区域复发预测参数的系统评价和荟萃分析得出“PREDICT”评分。
Updates Surg. 2021 Feb;73(1):35-46. doi: 10.1007/s13304-020-00853-z. Epub 2020 Jul 30.
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Total Mesorectal Excision Technique-Past, Present, and Future.全直肠系膜切除术技术——过去、现在与未来
Clin Colon Rectal Surg. 2020 May;33(3):134-143. doi: 10.1055/s-0039-3402776. Epub 2020 Apr 28.
7
The relationship between mesorectal grading and oncological outcome in rectal adenocarcinoma.直肠腺癌中直肠系膜分级与肿瘤学结局的关系。
Colorectal Dis. 2019 Mar;21(3):315-325. doi: 10.1111/codi.14535. Epub 2019 Jan 17.
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Association of Plane of Total Mesorectal Excision With Prognosis of Rectal Cancer: Secondary Analysis of the CAO/ARO/AIO-04 Phase 3 Randomized Clinical Trial.全直肠系膜切除平面与直肠癌预后的关系：CAO/ARO/AIO-04 期随机临床试验的二次分析。
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Review of the quality of total mesorectal excision does not improve the prediction of outcome.全直肠系膜切除术质量的回顾分析并未改善预后预测。
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Mesorectal pathologic assessment in two grades predicts accurately recurrence, positive circumferential margin, and correlates with survival.直肠系膜病理分级评估可准确预测复发、环周切缘阳性情况，并与生存率相关。
J Surg Oncol. 2015 Dec;112(8):900-6. doi: 10.1002/jso.24076. Epub 2015 Oct 21.