Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection
Rate of pathologic complete response with increased interval between preoperative combined modality therapy and rectal cancer resection
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DOI：
10.1007/s10350-003-0062-1
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发表时间：
2004-03-01
影响因子：
3.9
通讯作者：
Guillem, JG
中科院分区：
文献类型：
--
作者：
Moore, HG;Gittleman, AE;Guillem, JG
简介：最近的数据表明，对术前联合治疗获得病理完全缓解的直肠癌患者预后良好。延长术前联合治疗与手术之间的间隔（RT-手术间隔）作为提高病理完全缓解率的一种手段尚未得到充分研究。方法：确定了 155 名直肠癌患者，他们接受了术前盆腔外照射放射治疗和基于 5-氟尿嘧啶的化疗，随后进行了直肠切除术。所有患者在联合治疗前均接受直肠内超声检查。审查最终病理报告的 ypT 和 ypN 分期以及边缘状态。审查医疗记录中的括约肌保留情况、手术时间、估计失血量、住院时间和发病率（总体、吻合和会阴）。结果：24 名患者（15%）出现病理完全缓解 (ypTONO)。中位 RT 手术间隔为 44 天（范围 15-206）天。间隔时间 > 44 天的患者中，19% 的患者出现病理完全缓解，而间隔时间小于或等于 44 天的患者中，这一比例为 12% (P = 0.27)。长间隔组中降期三个阶段的频率更高（15% vs. 6%，P = 0.11）。括约肌保留率、切缘阳性、估计失血量和手术时间没有显着差异。各组之间的总体发病率相似。结论：我们的结果表明，随着放疗手术间隔的增加，病理完全缓解率和降期呈增加趋势。然而，括约肌的保存并没有增加。在进行前瞻性分析评估延长放疗手术间隔对长期结果的影响之前，延长术前联合治疗与手术完成之间的间隔的益处仍不清楚。
INTRODUCTION: Recent data suggest a favorable prognosis for rectal cancer patients with a pathologic complete response to preoperative combined modality therapy. Prolongation of the interval between preoperative combined modality therapy and surgery (RT-surgery interval) as a means of increasing pathologic complete response rate has not been fully examined. METHODS: One hundred and fifty-five rectal cancer patients undergoing preoperative pelvic external beam radiation therapy and 5-fluorouracil-based chemotherapy followed by rectal resection were identified. All patients had endorectal ultrasound prior to combined modality therapy. Final pathology reports were reviewed for ypT and ypN stage and margin status. Medical records were reviewed for sphincter preservation, operative time, estimated blood loss, hospital stay, and morbidity (overall, anastomotic, and perineal). RESULTS: A pathologic complete response (ypTONO) occurred in 24 patients (15 per-cent). Median RT-surgery interval was 44 (range, 15-206) days. A pathologic complete response occurred in 19 percent of patients with an interval >44 days, vs. 12 percent in those with an interval less than or equal to44 days (P = 0.27). Downstaging by three stages occurred more frequently in the long-interval group (15 percent vs. 6 percent, P = 0.11). The rates of sphincter preservation, positive margins, estimated blood loss, and operative time were not significantly different. Overall morbidity was similar between groups. CONCLUSIONS: Our results demonstrate a trend toward increased pathologic complete response rate and downstaging with increased RT-surgery interval. However, sphincter preservation is not increased. Until prospective analyses are conducted assessing the impact of prolonged RT-surgery interval on long-term outcome, the benefit of a prolonged interval between the completion of preoperative combined modality therapy and surgery remains unclear.