Impact of surgical and pathologic variables in rectal cancer: A United States Community and Cooperative Group Report
Impact of surgical and pathologic variables in rectal cancer: A United States Community and Cooperative Group Report
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DOI：
10.1200/jco.2001.19.18.3895
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发表时间：
2001-09-15
影响因子：
45.3
通讯作者：
Beart, R
中科院分区：
文献类型：
--
作者：
Stocchi, L;Nelson, H;Beart, R
目的：通过使用辅助治疗降低直肠癌手术后局部失败的风险已经取得了实质性和成功的努力。我们的研究检查了美国合作小组进行的研究数据，这些研究旨在调查手术和病理变量对直肠癌预后的影响。患者和方法：我们回顾了673例II/III期直肠癌患者的手术和病理报告，这些患者参加了三个辅助临床试验，以确定肿瘤和手术变量。收集了个别机构和手术医生的额外资料。在调整辅助治疗和其他重要预后因素后，测试变量与5年局部复发和生存的关系。结果：5年局部复发率为16%，生存率为59%。治疗多于10例的外科医生的局部复发率低于治疗少于或等于10例的外科医生（11% vs 17%, P = 0.02）。游离径向切缘也与局部复发相关（P = 0.01）。手术类型、远端缘和肿瘤径向扩散无显著性差异。肿瘤粘附邻近结构预测局部复发（35% v 14%, P < 0.001）和生存（30% v 63%, P < 0.001），无论整体切除。虽然T和N分类预测生存（P < 0.001），但只有N分类与局部复发相关。阳性淋巴结的数量和百分比与生存相关，但只有百分比独立预测局部复发。几个病理和手术变量报告不太理想。结论：在这一高危人群中发现了外科医生预后的中等变异性。努力改善手术结果需要改变报告实践，以便更准确地评估手术质量。[J]中华临床杂志，19(3):391 - 391。(C) 2001年美国临床肿瘤学会。
Purpose: Substantial and successful effort has been focused on decreasing the risk of local failure after rectal cancer surgery through the use of adjuvant therapies. Our study examined data from studies conducted by United States cooperative groups to investigate the impact of surgical and pathologic variables in rectal cancer outcomes.Patients and Methods: Surgical and pathologic reports from 673 patients with stage II/III rectal cancer enrolled onto three adjuvant clinical trials were reviewed for tumor and surgical variables. Additional information on individual institutions and operating surgeon was collected. Variables were tested for association with 5-year local recurrence and survival after adjustment for adjuvant treatments and other important prognostic factors.Results: Five-year local recurrence and survival rates were 16% and 59%, respectively. Surgeons treating more than 10 study cases had lower local recurrence rates than those treating less than or equal to 10 (11% v 17%, P = .02). Free radial margins also correlated with local recurrence (P = .01). Type of surgery, distal margins, and tumor radial spread were not significant. Tumor adherence to adjacent structures predicted local recurrence (35% v 14%, P < .001) and survival (30% v 63%, P < .001), regardless of en bloc resection. Although T and N classification predicted survival (P < .001), only N classification correlated with local recurrence. The number and percentage of positive nodes correlated with survival, but only the percentage independently predicted local recurrence. Several pathologic and surgical variables were reported suboptimally.Conclusion: Moderate variability in outcomes among surgeons was detected in this high-risk population. Efforts to improve surgical results will require changes in reporting practices to allow for more accurate assessment of the quality of surgery. J Clin Oncol 19:3895-3902. (C) 2001 by American Society of Clinical Oncology.