美国《临床肿瘤杂志》：直肠癌转移后的治疗策略

美国《临床肿瘤杂志》2017年6月28日在线先发

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

目的

局部晚期直肠癌术前放化疗随后进行全直肠系膜切除术后，局部或全身复发的患者可以进行根治性挽救性手术，但这种手术的获益情况尚未充分研究。本研究在接受多学科综合治疗的直肠癌患者中，旨在阐明肿瘤复发类型，并研究挽救性手术对生存期的影响。

患者与方法

我们找出1993年至2008年在我们医院治疗过的局部晚期直肠癌患者（cT3-4期或cN+期），这些患者接受过术前放化疗，随后进行了全直肠系膜切除术。我们对复发部位、复发时间、治疗因素和生存情况进行了研究。

结果

共纳入735名患者，大多数为中低位直肠癌，距肛缘距离中位数5.0cm。最常见的复发转移部位是肺脏，其次是肝脏，只有肝脏复发转移者中位复发转移时间（11.2个月）比只有肺脏复发转移（18.2个月）或只有局部区域性复发者（24.7个月，P=0.001）短。单一部位复发转移的患者有57%实施了挽救性手术，在只有肺转移或只有肝转移的患者中，挽救性手术与复发转移后生存期延长相关（P<0.001），但在只有局部区域性复发的患者中，没有这种相关性（P=0.353）。

结论

我们发现，在进行多学科综合治疗后的直肠癌患者中，有肺脏复发转移的倾向。在只有肺转移和只有肝转移的患者中，挽救性手术与生存期延长相关，但在局部区域性复发的患者中没有这种相关性，表明对手术切除的指征需要慎重考虑。

《壹篇》南南和北北

Purpose

After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment.

Patients and Methods

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

Results

A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-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 with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence (P < .001) but not in those with locoregional-only recurrence (P = .353).

Conclusion

We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

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