Predictive Factors and Risk Model for Positive Circumferential Resection Margin Rate After Transanal Total Mesorectal Excision in 2653 Patients With Rectal Cancer
Predictive Factors and Risk Model for Positive Circumferential Resection Margin Rate After Transanal Total Mesorectal Excision in 2653 Patients With Rectal Cancer
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DOI：
10.1097/sla.0000000000003516
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发表时间：
2019-11-01
影响因子：
9
通讯作者：
Hompes, Roel
中科院分区：
文献类型：
--
作者：
Roodbeen, Sapho X.;de lacy, F. B.;Hompes, Roel
目的：本研究的目的是确定经肛门全肠系膜切除术（TaTME）后阳性环切缘（CRM）的发生率和术前危险因素。背景：TaTME有可能进一步降低低位直肠癌患者的CRM阳性率，从而改善肿瘤预后。方法：对2014年7月至2018年1月期间在国际TaTME登记处记录的所有病例进行前瞻性登记研究。终点是阳性CRM的发生率和预测因素。进行单变量和多变量逻辑回归，然后通过制定预测模型评估积极客户关系管理的因素。结果：共纳入2653例直肠癌TaTME患者。CRM阳性发生率为107例（4.0%）。在多因素logistic回归分析中，TaTME术后CRM阳性与距肛肠结1 cm以内的肿瘤、前路肿瘤、cT4肿瘤、壁外静脉侵犯（EMVI）以及基线MRI上威胁或涉及CRM相关（比值比分别为2.09、1.66、1.93、1.94和1.72）。预测模型显示出足够的辨别能力（接受者-工作特征曲线下的面积>0.70），如果所有风险因素都存在，预测CRM阳性的风险为28%。结论：术前肿瘤相关的5个特征对TaTME术后的CRM累及有不利影响。该模型可以在术前计算特定患者TaTME后CRM阳性的预测风险，并有助于指导患者选择最佳治疗方案，并增强量身定制的治疗方法，以进一步优化肿瘤预后。
Objective: The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME).Background: TaTME has the potential to further reduce the rate of positive CRM for patients with low rectal cancer, thereby improving oncological outcome.Methods: A prospective registry-based study including all cases recorded on the international TaTME registry between July 2014 and January 2018 was performed. Endpoints were the incidence of, and predictive factors for, positive CRM. Univariate and multivariate logistic regressions were performed, and factors for positive CRM were then assessed by formulating a predictive model.Results: In total, 2653 patients undergoing TaTME for rectal cancer were included. The incidence of positive CRM was 107 (4.0%). In multivariate logistic regression analysis, a positive CRM after TaTME was significantly associated with tumors located up to 1 cm from the anorectal junction, anterior tumors, cT4 tumors, extra-mural venous invasion (EMVI), and threatened or involved CRM on baseline MRI (odds ratios 2.09, 1.66, 1.93, 1.94, and 1.72, respectively). The predictive model showed adequate discrimination (area under the receiver-operating characteristic curve >0.70), and predicted a 28% risk of positive CRM if all risk factors were present.Conclusion: Five preoperative tumor-related characteristics had an adverse effect on CRM involvement after TaTME. The predicted risk of positive CRM after TaTME for a specific patient can be calculated preoperatively with the proposed model and may help guide patient selection for optimal treatment and enhance a tailored treatment approach to further optimize oncological outcomes.