Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome
Impact of Interval between Neoadjuvant Chemoradiotherapy and TME for Locally Advanced Rectal Cancer on Pathologic Response and Oncologic Outcome
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DOI：
10.1245/s10434-012-2327-1
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发表时间：
2012-09-01
影响因子：
3.7
通讯作者：
D'Hoore, Andre
中科院分区：
文献类型：
--
作者：
Wolthuis, Albert M.;Penninckx, Freddy;D'Hoore, Andre
直肠癌新辅助放化疗和手术之间的间隔任意设定为6-8周。然而，肿瘤消退是可变的。本研究旨在评价新辅助治疗和手术之间的间隔是否对病理反应以及手术和肿瘤学结局有影响。中位年龄为63岁，65%为男性。所有患者均接受新辅助放化疗（45戈伊），并持续输注5-氟尿嘧啶。我们回顾了肿瘤-手术间隔时间、手术类型、病理学、术后并发症、住院时间、疾病复发和生存率。根据新辅助治疗与手术的间隔时间将患者分为两组：千分之一货币符号7周组（短间隔组，n = 201）和> 7周组（长间隔组，n = 155），病理完全缓解率为21%。在较长的间隔后（28%）显著高于较短的间隔后（16%，p = 0.006）。较长的间隔并不影响发病率或住院时间。在中位随访4.9年后，短间隔组的5年癌症特异性生存率为83%，而长间隔组为91（p = 0.046），无复发率分别为73%和83%，（p = 0.026）。在这项回顾性分析中，新辅助放化疗后较长的间隔时间似乎与完全的病理反应有关，而不影响术后发病率和时间的住院时间，并且对肿瘤学结果没有不利影响。
The interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer has arbitrarily been set at 6-8 weeks. However, tumor regression is variable. This study aimed to evaluate whether the interval between neoadjuvant therapy and surgery had an impact on pathologic response and on surgical and oncologic outcome.A total of 356 consecutive patients with clinical stage II and III rectal adenocarcinoma were identified. Median age was 63 years, and 65 % were men. All patients received neoadjuvant chemoradiotherapy (45 Gy) with a continuous infusion of 5-fluorouracil. Data on neoadjuvant-surgery interval, type of surgery, pathology, postoperative complications, length of hospital stay, disease recurrence, and survival were reviewed. Patients were divided into two groups according to the interval between neoadjuvant therapy and surgery: a parts per thousand currency sign7 weeks (short interval, n = 201) and > 7 weeks (long interval, n = 155).The complete pathologic response rate was 21 %. It was significantly higher after a longer interval (28 %) than after a shorter interval (16 %, p = 0.006). A longer interval did not affect morbidity or length of hospital stay. After a median follow-up of 4.9 years, the 5-year cancer-specific survival rate was 83 % in the short-interval group versus 91 % in the long-interval group (p = 0.046), and the free-from-recurrence rate was 73 versus 83 %, respectively (p = 0.026).In this retrospective analysis, there seems to be an association between a longer interval after neoadjuvant chemoradiotherapy and complete pathologic response without affecting postoperative morbidity and length of hospital stay, and with no detrimental effect on oncologic outcome.