Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy
Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy
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DOI：
10.1007/s10350-004-6250-9
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发表时间：
2002-05-01
影响因子：
3.9
通讯作者：
Minsky, BD
中科院分区：
文献类型：
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作者：
Shoup, M;Guillem, JG;Minsky, BD
目的：因此，本研究旨在确定直肠癌复发患者术后和术中放疗后生存的预测因素。方法：从一个前瞻性数据库中，确定了1990年1月至2000年6月期间接受直肠癌复发切除术的634例患者。在这些患者中，111人接受了具有治疗意图的术中放疗，100人可用于随访。通过多变量COX回归和LOG-RANK检验，评价初次手术和复发手术的临床病理变量作为无病生存率和疾病特异性生存率的预测因素。结果：男54例，女46例，年龄37~83岁，中位数57岁。中位随访时间为23.2个月，60名患者(60%)复发：20名(33%)局部复发，27名(45%)远程复发，13名(22%)两个部位复发。在分析的所有变量中，只有完全切除且显微镜下切缘为阴性且复发标本中没有血管侵犯，才能预测无病生存率和疾病特异性生存率的改善(P<；0.01)。完全切除组的中位无病生存期和中位疾病特异性生存期分别为31.2个月和66.1个月，而切缘显微镜或大体呈阳性的切除组分别为7.9个月和22.8个月(P<；0.01)。复发标本中有血管侵犯的中位无病生存期和中位疾病特异性生存期分别为6.4个月和16.1个月，而无血管侵犯的中位无病生存期和中位疾病特异性生存期分别为23.3个月和57.3个月(P<；0.01和P<；0.05)。完全切除和无血管侵犯也是局部控制改善的唯一预测因素(P<；0.05和P<；0.01)。结论：切除切缘阴性和无血管侵犯是复发直肠癌切除加术中放疗后局部控制和提高生存率的独立预测因素。
PURPOSE: Thus study was designed to determine predictors of survival after surgery and intraoperative radiotherapy for recurrent rectal cancer. METHODS: From a prospective database, 634 patients undergoing resection for recurrent rectal cancer between January 1990 and June 2000 were identified. Of these, 111 received intraoperative radiotherapy with curative intent, and 100 were available for followup. Clinicopathologic variables from both the primary and recurrent operations were evaluated as predictors of disease-free and disease-specific survival by multivariate Cox regression and log-rank test. RESULTS: There were 54 males and 46 females, with a median age of 57 (range, 37-83) years. With a median follow-up of 23.2 months, 60 patients (60 percent) recurred: 20 (33 percent) locally, 27 (45 percent) distantly, and 13 (22 percent) at both sites. Of all variables analyzed, only complete resection with microscopically negative margins and the absence of vascular invasion in the recurrent specimen predicted improved disease-free and disease-specific survival (P < 0.01 for all). Median disease-free survival and median disease-specific survival were 31.2 and 66.1 months, respectively, for complete resection compared with 7.9 and 22.8 months for resection with microscopic or grossly positive margins (P < 0.01 for both). Median disease-free survival and median disease-specific survival were 6.4 and 16.1 months, respectively, in the presence of vascular invasion in the recurrent specimen compared with 23.3 and 5 7.3 months in the absence of vascular invasion (P < 0.01 and P < 0.05, respectively). Complete resection and the absence of vascular invasion were the only predictors of improved local control as well (P < 0.05 and P < 0.01, respectively). CONCLUSION: Resection with negative microscopic margins and absence of vascular invasion are independent predictors of local control and improved survival after resection and intraoperative radiotherapy for recurrent rectal cancer.