ROLE OF CIRCUMFERENTIAL MARGIN INVOLVEMENT IN THE LOCAL RECURRENCE OF RECTAL-CANCER

ROLE OF CIRCUMFERENTIAL MARGIN INVOLVEMENT IN THE LOCAL RECURRENCE OF RECTAL-CANCER
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DOI：
10.1016/s0140-6736(94)92206-3
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发表时间：
1994-09-10
期刊：
LANCET
影响因子：
168.9
通讯作者：
QUIRKE, P
QUIRKE, P
中科院分区：
医学1区
文献类型：
--
作者：
ADAM, IJ;MOHAMDEE, MO;QUIRKE, P

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直肠癌切除术后局部复发仍然很常见，尽管越来越多的人认为局部切除不充分可能与直肠癌复发有关。在一项190例直肠癌患者的前瞻性研究中，我们检查了切除标本的环切缘是否存在肿瘤，以检查其频率及其与随后局部复发的关系。在外科医生认为切除可能治愈的标本中，25%（35/141）的环切缘肿瘤受累，36%（69/190）的病例有此症状。中位随访5年（范围3.0-7.7年）后，潜在根治性切除术后局部复发率为25%（95%CI 18-33%）。肿瘤累及环周边缘的患者的局部复发率显著高于无此类累及的患者（78 [95% CI 62-94] vs 10 [4-16]%）。通过考克斯回归分析，肿瘤周向边缘受累独立影响局部复发和复发率，（风险比=12.2 [4.4-34.6]）和生存期（3.2 [1.6-6.53]）。这些结果表明在直肠癌切除术中广泛局部切除的重要性，以及需要常规评估环周边缘以评估对生存的显著影响，而另一种预测。
Local recurrence after resection for rectal cancer remains common despite growing acceptance that inadequate local excision may be implicated. In a prospective study of 190 patients with rectal cancer, we examined the circumferential margin of excision of resected specimens for tumour presence, to examine its frequency and its relation to subsequent local recurrence.Tumour involvement of the circumferential margin was seen in 25% (35/141) of specimens for which the surgeon thought the resection was potentially curative, and in 36% (69/190) of all cases. After a median 5 years' follow-up (range 3.0-7.7 years), the frequency of local recurrence after potentially curative resection was 25% (95% Cl 18-33%). The frequency of local recurrence was significantly higher for patients who had had tumour involvement of the circumferential margin than for those without such involvement (78 [95% Cl 62-94] vs 10 [4-16]%). By Cox's regression analysis tumour involvement of the circumferential margin independently influenced both local recurrence (hazard ratio=12.2 [4.4-34.6]) and survival (3.2 [1.6-6.53]).These results show the importance of wide local excision during resection for rectal cancer, and the need for routine assessment of the circumferential margin to assess significant influence on survival, whereas the other prognosis.