Prognostic factors for local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision.

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL Clinics Pub Date : 2024-08-09 eCollection Date: 2024-01-01 DOI:10.1016/j.clinsp.2024.100464

Caio Sergio Rizkallah Nahas, Sergio Carlos Nahas, Carlos Frederico Sparapan Marques, Ulysses Ribeiro Junior, Leonardo Bustamante-Lopez, Guilherme Cutait Cotti, Antonio Rocco Imperiale, Rodrigo Ambar Pinto, Ivan Cecconello

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Abstract

Prognostic factors for local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision.

Background: The standard curative treatment for locally advanced rectal cancer of the middle and lower thirds is long-course chemoradiotherapy followed by total mesorectal excision.

Purpose: To evaluate the prognostic factors associated with local recurrence in patients with rectal cancer submitted to neoadjuvant chemoradiotherapy and total mesorectal excision.

Methods: Retrospective study including patients with rectal cancer T3-4N0M0 or T (any)N + M0 located within 10 cm from the anal border, or patients with T2N0M0 located within 5 cm, treated by long course chemoradiotherapy followed by total mesorectal excision with curative intent. Clinical, demographic, radiologic, surgical, and anatomopathological data were collected. Local recurrence was estimated using the Kaplan-Meier function, and risk was estimated according to each characteristic using univariate and multivariate analyses.

Results: 270 patients were included, 57.8% male and mean age 61.7 (30‒88) years. At initial staging, 6.7% of patients were stage I, 21.5% stage II, and 71.8% stage III. Open surgery was performed in 65.2%, with sphincter preservation in 78.1%. Mortality within 30 postoperative days was 0.7%. After 49.4 (0.5‒86.1) months of median follow-up, overall and local recurrences were 26.3% and 5.9%. On multivariate analyses, local recurrence was associated with involvement of the mesorectal fascia on restaging MRI (HR = 9.11, p = 0.001) and with pathologic involvement of radial surgical margin (HR = 8.19, p < 0.001).

Conclusion: Local recurrence of rectal cancer treated with long-course chemoradiation and total mesorectal excision is low and is associated with pathologic involvement of the radial surgical margin and can be predicted on restaging MRI.

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接受新辅助化放疗和全直肠系膜切除术的直肠癌患者局部复发的预后因素。

接受新辅助化放疗和全直肠系膜切除术的直肠癌患者局部复发的预后因素：目的：评估接受新辅助化疗和全直肠系膜切除术的直肠癌患者局部复发的相关预后因素：回顾性研究：包括直肠癌T3-4N0M0或T(任意)N+M0位于肛门边界10厘米以内的患者，或T2N0M0位于5厘米以内的患者，采用长程化放疗治疗，然后以治愈为目的进行全直肠系膜切除术。研究人员收集了临床、人口统计学、放射学、手术和解剖病理学数据。采用 Kaplan-Meier 函数估算局部复发率，并根据每个特征采用单变量和多变量分析估算风险。初步分期时，6.7%的患者为Ⅰ期，21.5%为Ⅱ期，71.8%为Ⅲ期。65.2%的患者接受了开放手术，78.1%的患者保留了括约肌。术后 30 天内的死亡率为 0.7%。经过49.4（0.5-86.1）个月的中位随访，总体和局部复发率分别为26.3%和5.9%。多变量分析显示，局部复发与MRI重分期时直肠系膜筋膜受累（HR = 9.11，P = 0.001）和手术边缘径向病理受累（HR = 8.19，P < 0.001）有关：结论：采用长程化疗和全直肠系膜切除术治疗的直肠癌局部复发率较低，且与桡侧手术切缘的病理受累有关，并可通过磁共振成像重分期进行预测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.