美國《臨床腫瘤雜誌》2017年6月28日在線先發

http://ascopubs.org/doi/full/10.1200/JCO.2016.72.1464

複發轉移和挽救性手術對直腸癌多學科綜合治療後生存期的影響

目的

局部晚期直腸癌術前放化療隨後進行全直腸系膜切除術后，局部或全身複發的患者可以進行根治性挽救性手術，但這種手術的獲益情況尚未充分研究。本研究在接受多學科綜合治療的直腸癌患者中，旨在闡明腫瘤複發類型，並研究挽救性手術對生存期的影響。

患者與方法

我們找出1993年至2008年在我們醫院治療過的局部晚期直腸癌患者（cT3-4期或cN+期），這些患者接受過術前放化療，隨後進行了全直腸系膜切除術。我們對複發部位、複發時間、治療因素和生存情況進行了研究。

結果

共納入735名患者，大多數為中低位直腸癌，距肛緣距離中位數5.0cm。最常見的複發轉移部位是肺臟，其次是肝臟，只有肝臟複發轉移者中位複發轉移時間（11.2個月）比只有肺臟複發轉移（18.2個月）或只有局部區域性複發者（24.7個月，P=0.001）短。單一部位複發轉移的患者有57%實施了挽救性手術，在只有肺轉移或只有肝轉移的患者中，挽救性手術與複發轉移後生存期延長相關（P<0.001），但在只有局部區域性複發的患者中，沒有這種相關性（P=0.353）。

結論

我們發現，在進行多學科綜合治療后的直腸癌患者中，有肺臟複發轉移的傾向。在只有肺轉移和只有肝轉移的患者中，挽救性手術與生存期延長相關，但在局部區域性複發的患者中沒有這種相關性，表明對手術切除的指征需要慎重考慮。

《壹篇》南南和北北

Impact of Recurrence and Salvage Surgery on SurvivalAfter Multidisciplinary Treatment of RectalCancer

Purpose

After preoperative chemoradiotherapy followed by totalmesorectal excision for locally advanced rectal cancer, patientswho experience local or systemic relapse of disease may be eligiblefor curative salvage surgery, but the benefit of this surgery hasnot been fully investigated. The purpose of this study was tocharacterize recurrence patterns and investigate the impact ofsalvage surgery on survival in patients with rectal cancer afterreceiving multidisciplinary treatment.

Patients and Methods

Patients with locally advanced (cT3-4 or cN+) rectal cancer whowere treated with preoperative chemoradiotherapy followed by totalmesorectal excision at our institution during 1993 to 2008 wereidentified. We examined patterns of recurrence location, time torecurrence, treatment factors, and survival.

Results

A total of 735 patients were included. Tumors were mostlymidrectal to lower rectal cancer, with a median distance from theanal verge of 5.0 cm. The most common recurrence site was the lungfollowed by the liver. Median time to recurrence was shorter inliver-only recurrence (11.2 months) than in lung-only recurrence(18.2 months) or locoregional-only recurrence (24.7 months; P =.001). Salvage surgery was performed in 57% of patients withsingle-site recurrence and was associated with longer survivalafter recurrence in patients with lung-only and liver-onlyrecurrence (P < .001) but not in those with locoregional-onlyrecurrence (P = .353).

Conclusion

We found a predilection for lung recurrence in patients withrectal cancer after multidisciplinary treatment. Salvage surgerywas associated with prolonged survival in patients with lung-onlyand liver-only recurrence, but not in those with locoregionalrecurrence, which demonstrates a need for careful consideration ofthe indications for resection.

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