A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision
A pathologic complete response to preoperative chemoradiation is associated with lower local recurrence and improved survival in rectal cancer patients treated by mesorectal excision
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DOI：
10.1007/s10350-004-6545-x
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发表时间：
2003-03-01
影响因子：
3.9
通讯作者：
Rothenberger, DA
中科院分区：
文献类型：
--
作者：
García-Aguilar, J;de Anda, EH;Rothenberger, DA
目的：术前放化疗减少直肠癌患者的肿瘤大小和淋巴结转移。肿瘤分期降低与保肛手术的可能性增加和局部控制改善相关。然而，病理学完全反应放化疗尚未与局部控制和患者生存。我们研究了直肠癌患者术前放化疗病理完全缓解的预后价值。方法：我们前瞻性随访了168例连续的超声II期（46例）和III期（122例）直肠癌患者，这些患者接受术前放化疗，然后进行根治性切除术和直肠系膜切除术; 161例进行了根治性切除术。复发率和生存率与肿瘤特征和病理完全缓解进行比较。平均随访37个月。结果：97例（58%）患者发生肿瘤降级，其中21例（13%）患者病理完全缓解。临床或病理变量均与病理完全缓解无关。估计5年局部复发率为5%，远处转移率为14%。病理学完全缓解的患者均未出现疾病复发。我们发现病理分期为I、II或III期肿瘤患者的生存率无差异。结论：术前放化疗的病理完全反应与改善局部控制和患者生存率相关。对于无病理完全缓解的患者，病理分期无预后意义。
PURPOSE: Preoperative chemoradiation reduces tumor size and nodal metastasis in patients with rectal cancer. Tumor downstaging has been associated with an increased probability of a sphincter-saving procedure and with improved local control. However, pathologic complete response to chemoradiation has not been correlated with local control and patient survival. We studied the prognostic value of pathologic complete response to preoperative chemoradiation in rectal cancer patients. METHODS: We have prospectively followed up 168 consecutive patients with ultrasound Stages II (46) and III (122) rectal cancer treated by preoperative chemoradiation followed by radical resection with mesorectal excision; 161 had a curative resection. Recurrence and survival were compared with tumor characteristics and pathologic complete response. Average follow-up was 37 months. RESULTS: Tumor downstaging occurred in 97 (58 percent) patients, including 21 (13 percent) patients who had a pathologic complete response. None of the clinical or pathologic variables was associated with pathologic complete response. The estimated 5-year rate of local recurrence was 5 percent; of distant metastasis, 14 percent. None of the patients with pathologic complete response has developed disease recurrence. We found no difference in survival among patients with pathologic Stages I, II, or III tumors. CONCLUSIONS: A pathologic complete response to preoperative chemoradiation is associated with improved local control and patient survival. For patients without pathologic complete response, the pathology stage does not have prognostic significance.