Therapeutic effects and limitations of chemoradiotherapy in advanced lower rectal cancer focusing on T4b
Therapeutic effects and limitations of chemoradiotherapy in advanced lower rectal cancer focusing on T4b
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以T4b为重点的晚期低位直肠癌放化疗的疗效及局限性
DOI：
10.1007/s00384-021-03936-4
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发表时间：
2021
影响因子：
2.8
通讯作者：
Ishihara Soichiro
中科院分区：
文献类型：
--
作者：
Ozaki Kosuke;Kawai Kazushige;Nozawa Hiroaki;Sasaki Kazuhito;Murono Koji;Emoto Shigenobu;Iida Yuuki;Ishii Hiroaki;Yokoyama Yuichiro;Anzai Hiroyuki;Sonoda Hirofumi;Sugihara Kenichi;Ishihara Soichiro
目的本研究旨在阐明术前放化疗（CRT）在直肠癌，特别是T4b直肠癌治疗中的益处和局限性。方法本回顾性队列研究回顾了1014例连续在东京大学医院外科肿瘤科和22家日本结直肠癌术后随访研究组下属转诊机构行全肠系膜切除术的临床下直肠T3/4a/T4b腺癌患者。患者被分为两个队列：队列1包括298名连续接受CRT和根治性手术的患者，队列2包括716名连续接受根治性手术而不进行术前治疗的患者。我们评估了两组患者的预后差异，特别关注T期。结果T3/4a组患者局部复发率1明显低于队列2 (4.8% vs. 9.4%,p=0.024)， T4b组患者局部复发率23.5% vs. 16.0%,p=0.383)。相比之下，T3/4a和T4b患者的生存期无显著差异。在队列1中发现T4b分类是局部复发的独立预测因素，而在队列2中则不是。结论在T4b直肠癌中，术前CRT对局部控制和生存的益处有限。在疑似T4b直肠肿瘤的病例中，在常规CRT的基础上进行诱导化疗等额外治疗可能有助于获得更好的结果。
PurposeThis study aimed to elucidate the benefits and limitations of preoperative chemoradiotherapy (CRT) in rectal cancer treatment, specifically in T4b rectal cancer.MethodsThis retrospective cohort study reviewed 1014 consecutive patients with clinical T3/4a/T4b adenocarcinomas of the lower rectum, who underwent total mesorectal excision at the Department of Surgical Oncology of the University of Tokyo Hospital and 22 referral institutions affiliated with the Japanese Study Group for Postoperative Follow-up of Colorectal Cancer. Patients were divided into two cohorts: cohort 1 comprised 298 consecutive patients who underwent CRT followed by radical surgery and cohort 2 comprised 716 consecutive patients who underwent curative surgery without preoperative therapy. We assessed the prognostic differences between the two cohorts, focusing particularly on T stages.ResultsIn T3/4a patients, cohort 1 showed a significantly lower local recurrence rate than cohort 2 (4.8% vs. 9.4%,p=0.024), but not in T4b patients (23.5% vs. 16.0%,p=0.383). In contrast, no significant differences in survival were observed between T3/4a and T4b patients. T4b classification was found to be an independent predictive factor of local recurrence in cohort 1, but not in cohort 2.ConclusionIn T4b rectal cancer, preoperative CRT demonstrated a limited benefit for local control and survival. In cases of suspected T4b rectal tumors, additional therapies such as induction chemotherapy to conventional CRT may contribute to better outcomes.
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DOI：
10.6004/jnccn.2018.0061
发表时间：
2018-07
期刊：
Journal of the National Comprehensive Cancer Network : JNCCN
影响因子：
--
作者：
Benson AB;Venook AP;Al-Hawary MM;Cederquist L;Chen YJ;Ciombor KK;Cohen S;Cooper HS;Deming D;Engstrom PF;Grem JL;Grothey A;Hochster HS;Hoffe S;Hunt S;Kamel A;Kirilcuk N;Krishnamurthi S;Messersmith WA;Meyerhardt J;Mulcahy MF;Murphy JD;Nurkin S;Saltz L;Sharma S;Shibata D;Skibber JM;Sofocleous CT;Stoffel EM;Stotsky-Himelfarb E;Willett CG;Wuthrick E;Gregory KM;Gurski L;Freedman-Cass DA
通讯作者：
Freedman-Cass DA
影响因子：
9
作者：
Lehnert, T;Methner, M;Herfarth, C
通讯作者：
Herfarth, C
影响因子：
9.6
作者：
Koda, K;Tobe, T;Miyazaki, M
通讯作者：
Miyazaki, M
影响因子：
2.8
作者：
MONTESANI, C;RIBOTTA, G;JAUS, M
通讯作者：
JAUS, M
整块切除粘附于其他器官的结肠癌：有效的治疗方法吗？
影响因子：
3.9
作者：
H. Kroneman;A. Castelein;J. Jeekel
通讯作者：
J. Jeekel