Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer - Impact of postirradiated pathologic downstaging on local recurrence and survival
Oncologic outcomes after neoadjuvant chemoradiation followed by curative resection with tumor-specific mesorectal excision for fixed locally advanced rectal cancer - Impact of postirradiated pathologic downstaging on local recurrence and survival
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DOI：
10.1097/01.sla.0000225360.99257.73
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发表时间：
2006-12-01
影响因子：
9
通讯作者：
Cho, Chang Hwan
中科院分区：
文献类型：
--
作者：
Kim, Nam Kyu;Baik, Seung Hyuk;Cho, Chang Hwan
目的：本研究的目的是确定局部晚期、固定性直肠癌在肿瘤特异性直肠系膜切除术后接受新辅助放化疗的患者的肿瘤学结果和影响生存的临床因素。背景数据摘要：新辅助放化疗导致肿瘤显着降期，从而增强了根治性切除，随后改善了直肠癌的局部疾病控制。 癌症。然而，根据临床因素，局部晚期和固定直肠癌的肿瘤学结局尚未完全了解。方法：对 114 例接受新辅助放化疗的晚期直肠癌（T3 或 T4 且淋巴结阳性）患者进行回顾性调查。在放疗的第 1 周和第 5 周期间，静脉注射 5-FU 和亚叶酸进行化疗。 5 周内分 25 次照射，总辐射剂量为 5040 cGY。新辅助放化疗结束后4至6周进行肿瘤特异性直肠系膜切除术。根据病理阶段评估生存率和复发率。此外，还调查了影响生存的因素。结果：不同病理分期的5年生存率分别为：病理完全缓解（n = 10）100％，I期（n = 23）80％，II期（n = 34）56.8％，III期（n = 47）42.3％（P = 0.0000）。局部、全身和综合复发率分别为 11.4%、22.8% 和 3.5%。多因素分析显示病理N分期和手术方式是影响生存率的独立因素。结论：病理完全缓解显示良好的肿瘤预后，其中病理N分期是影响肿瘤预后的最重要因素。
Objective: The purpose of this study was to deter-mine the oncologic Outcomes and clinical factors affecting survival in patients who underwent neoadjuvant chemoradiotherapy following tumor specific mesorectal excision for locally advanced, fixed rectal cancer.Summary Background Data: Neoadjuvant chemoradiation therapy has resulted in significant tumor downstaging, which enhances curative resection and subsequently improves local disease control for rectal cancer. However, oncologic outcomes, according to clinical factors, have not yet been fully understood in locally advanced and fixed rectal cancer.Methods: A total of 114 patients who had undergone neoadjuvant chemoradiation for advanced rectal cancer (T3 or T4 and node positive) were investigated retrospectively. Chemotherapy was administered intravenously with 5-FU and leucovorin during weeks 1 and 5 of radiotherapy. The total radiation dose was 5040 cGY in 25 fractions delivered over 5 weeks. Tumor-specific mesorectal excision was done 4 to 6 weeks after the completion of neoadjuvant chemoradiation. Survival and recurrence rates, according to the pathologic stage, were evaluated. Moreover, factors affecting survival were investigated.Results: The 5-year survival rates according to pathologic stage were: 100% in pathologic complete remission (n = 10), 80% in stage I (n = 23), 56.8% in stage II (n = 34), and 42.3% in stage III (n = 47) (P = 0.0000). Local, systemic, and combined recurrence rates were 11.4%, 22.8%, and 3.5%, respectively. Multivariate analysis showed that the pathologic N stage and operation method were the independent factors affecting survival rate.Conclusion: Pathologic complete remission showed excellent oncologic outcomes, and the pathologic N stage was the most important factor for oncologic outcomes.