Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer
Clinical and pathologic predictors of locoregional recurrence, distant metastasis, and overall survival in patients treated with chemoradiation and mesorectal excision for rectal cancer
复制标题
DOI：
10.1097/01.coc.0000214930.78200.4a
复制
发表时间：
2006-06-01
影响因子：
2.6
通讯作者：
Crane, CH
中科院分区：
文献类型：
--
作者：
Das, P;Skibber, JM;Crane, CH
目的：探讨直肠癌放化疗后局部复发(LR)、远处转移(DM)和总生存期(OS)的预测因素。方法：1989~2001年间，470例直肠癌患者接受了术前(89%)或术后(11%)放化疗加直肠系膜切除术。中位放射剂量为45Gy.97%的患者同时接受5-氟尿嘧啶输注，65%的患者接受辅助化疗。中位随访期为5.7年。结果：5年内脱离LR、DM和OS的生存率分别为90%、79%和80%。单因素分析显示，女性性别、临床T分期、病理T分期、N分期、放射状切缘阳性是LR的显著预测因素。有意义的单变量预测因素是肿瘤周围范围、肿瘤静止、淋巴血管侵犯、神经周围受累以及病理T和N分期。年龄、肿瘤周围范围、距肛缘较短距离、肿瘤大小、肿瘤静止、肛管侵犯、淋巴管侵犯、神经周围侵犯、放射状切缘阳性、病理T和N分期是低OS的显著单变量预测因素。COX多因素分析显示，女性性别和病理T、N分期对LR有独立预测作用，病理T、N分期对DM有独立预测作用，年龄、肿瘤周缘、放射缘阳性、病理T、N分期对低OS有独立预测作用。结论：在多因素分析中，病理T、N分期对LR、DM和OS均有显著影响。对于病理分期为T3/T4或N1/2的直肠癌，似乎有必要进行更积极的辅助化疗。
Objectives: To identify predictive factors for locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) in patients treated with chemoradiation and surgery for rectal cancer.Methods: Between 1989 and 2001, 470 patients with rectal cancer were treated with preoperative (89%) or postoperative (11%) chemoradiation and mesorectal excision. Median radiation dose was 45 Gy; 97% received concurrent infusional 5-fluorouracil, and 65% received adjuvant chemotherapy. Median follow-up interval was 5.7 years.Results: The 5-year rates of freedom from LR, freedom from DM, and OS were 90%, 79%, and 80%, respectively. On univariate analysis, significant predictors of LR were female sex, clinical T stage, pathologic T and N stages, and positive radial margin. Significant univariate predictors of DM were circumferential extent of tumor, tumor immobility, lymphovascular invasion, perineural involvement, and pathologic T and N stages. Significant univariate predictors of lower OS were age, circumferential extent of tumor, shorter distance from anal verge, tumor size, tumor immobility, anal canal involvement, lymphovascular invasion, perineural involvement, positive radial margin, and pathologic T and N stages. On Cox multivariate analysis, female sex and pathologic T and N stages independently predicted for LR; pathologic T and N stages independently predicted for DM; and age, circumferential extent of tumor, positive radial margin, and pathologic T and N stages independently predicted for lower OS.Conclusions: Pathologic T and N stages significantly predicted for all 3 end points (LR, DM and OS) on multivariate analysis. Investigations of more aggressive adjuvant chemotherapy appear warranted for pathologic stage T3/T4 or N1/2 rectal cancer.