Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis
Mucinous Rectal Cancer: Effectiveness of Preoperative Chemoradiotherapy and Prognosis
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DOI：
10.1245/s10434-011-1612-8
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发表时间：
2011-08-01
影响因子：
3.7
通讯作者：
Kim, Jin Cheon
中科院分区：
文献类型：
--
作者：
Shin, Ui Sup;Yu, Chang Sik;Kim, Jin Cheon
本研究调查术前放化疗（PCRT）的效果和粘液性直肠癌与非粘液性直肠癌患者的预后，回顾性分析了2000年至2006年期间368例直肠中下段腺癌患者在PCRT后接受根治性切除术的病历。粘液癌23例（6.3%），非粘液癌345例。在每例患者中，将放化疗前的临床分期与病理分期进行比较，以评估降级的程度。使用临床病理变量进行生存和多变量分析。中位随访时间为42个月（范围，4-105个月），两组间临床分期无差异。虽然非粘液性组中有58例患者（16.8%）达到病理完全缓解（pCR），但粘液性组患者无此反应。非粘液性组中T分期降低的发生率高于粘液性组（189例vs 7例[54.9% vs 30.4%]，P = 0.03），但两组中N分期降低的发生率相似。粘液性组的5年总生存率（OS）显著低于非粘液性组（64.8% vs 79.8%，P = 0.049）。多变量分析显示，粘液性组织型是影响生存率的独立（阴性）预后因素（风险比，2.36; 95%可信区间，1.05-5.3; P = .04），与非粘液性直肠癌患者相比，粘液性直肠癌患者PCRT后T分期下调率较低，预后较差。
This study investigated the effects of preoperative chemoradiotherapy (PCRT) and the prognoses of patients with mucinous rectal cancer compared with those with nonmucinous cancer.We retrospectively reviewed the medical records of 368 patients who underwent curative resection after PCRT, between 2000 and 2006, for midrectal to lower-rectal adenocarcinoma. Mucinous cancers were present in 23 patients (6.3%) and nonmucinous cancers in 345. In each patient, clinical stage before chemoradiotherapy was compared with pathologic stage to evaluate the extent of downstaging. Survival and multivariate analyses were performed using clinicopathologic variables. The median follow-up period was 42 months (range, 4-105 months).There was no difference in clinical stage between the groups. Although 58 patients (16.8%) in the nonmucinous group achieved pathologic complete responses (pCR), no mucinous group patient showed such a response. T-downstaging was more frequently observed in the nonmucinous than in the mucinous group (189 vs 7 [54.9% vs 30.4%], P = .03), but N-downstaging was similar in the 2 groups. The 5-year overall survival rate (OS) was significantly lower in the mucinous than in the nonmucinous group (64.8% vs 79.8%, P = .049). Multivariate analysis revealed that mucinous histotype was an independent (negative) prognostic factor for survival (hazard ratio, 2.36; 95% confidence interval, 1.05-5.3; P = .04).Patients with mucinous rectal cancer experienced a lower rate of T-downstaging after PCRT and had a poorer prognosis than did patients with nonmucinous cancer.