Prognostic Factors Affecting the Outcome of Rectal Cancer Patients Receiving Preoperative Chemoradiotherapy Followed by Surgery

直腸癌病人接受手術前同步化學放射治療之預後因子分析

林士鈞(Shih-Chun Lin) ； 劉幕台(Mu-Tai Liu) ； 畢祖平(Chu-Ping Pi) ； 張東浩(Tung-Hao Chang) ； 黃昭源(Chao-Yuan Huang) ； 許智捷(Chih-Chiech Hsu) ； 黃家俊(Chia-Chun Huang)

《放射治療與腫瘤學》 17卷3期 (2010/09) Pp. 213-225

https://doi.org/10.6316/TRO/201017(3)213

摘要

目的：統計直腸癌病人在本院接受手術前同步化學放射治療後的整體存活率及局部區域控制率，並且分析預後因子。
材料與方法：自1999年1月到2007年8月，有70位被診斷為直腸癌的病人在本院接受手術前同步化學放射治療。手術前接受化學治療(5-Fluorouracil+Leucovorin)和體外放射治療（劑量範圍4140cGy至5940cGy）。在手術前同步化學放射治療結束之後，所有的病人都會接受根除性的手術。術式包括abdominoperineal resection, low anterior resection 和Hartmann's procedure。我們分析以下的預後因子對於整體存活率的影響：年齡、性別、手術前的臨床分期、手術後的病理分期、手術切除的腫瘤大小、腫瘤與肛門口的距離。
結果：病人的年齡中位數是60.3歲（範圍介於28至85歲）。有12個病人(17.1%)發生局部復發，27個病人(38.6%)發生遠處轉移。追蹤時間中位數是42個月（範圍從3至114個月）。1年、3年和5年的整體存活率分別為89.3%、52.9%及36.9%。在單變項分析中，手術前的T分期、手術後的N分期、以及手術切除的腫瘤大小是有意義的預後因子。而在多變項分析中，手術前的T分期、手術後的N分期、以及手術切除的腫瘤大小仍然是有意義的預後因子。
結論：我們認為當病人接受手術前同步化學放射治療之後，在手術切除的標本中，如果淋巴結有腫瘤細胞的存在對於整體存活率有重要的影響。而在手術前的T分期和手術所切除的腫瘤大於4公分也是有意義的預後因子。不過仍然需要更大型的研究來確認我們的結論並且找出最適當的治療方式。

關鍵字

直腸癌 ； 手術前同步化學放射治療 ； 預後因子

並列摘要

Purpose: The purpose of this study is to investigate the overall survival and local control of patients with rectal cancer scheduled to receive preoperative chemoradiotherapy (CRT). We analyze the prognostic factors affecting their outcomes.
Materials and Methods: From January 1999 to August 2007, 70 patients with the diagnosis of rectal cancer treated at our institution were included in this study. The preoperative treatment consisted of chemotherapy (5-Fluorouracil plus Leucovorin) and external-beam radiotherapy (ranged from 4140 cGy to 5940 cGy). After the CRT course, surgical intervention was performed in all of the patients. Surgical procedures included abdominoperineal resection, low anterior resection, and Hartmann's procedure. We analyzed the following factors to evaluate their impact on overall survival: age of diagnosis, gender, clinical T and N stage at initial diagnosis, pathologic T and N stage after surgery, tumor size at surgical resection, and distance of tumor from anal verge.
Results: The median age of diagnosis of rectal cancer was 60.3 years old (ranged from 28 to 85 years old). Local recurrence occurred in 12 patients (17.1%) and distant metastasis occurred in 27 patients (38.6%). The median follow-up duration was 42 months (ranged from 3 to 114 months). The 1-year, 3-year and 5-year overall survival rates were 89.3%, 52.9% and 36.9%, respectively. In univariate analysis, clinical T stage (p=0.0047), pathologic N stage (p=0.0023), and tumor size at surgical resection (p=0.0009) were statistically significant prognostic factors for overall survival. In multivariate analysis, clinical T stage (p=0.017), pathologic N stage (p=0.004) and tumor size at surgical resection (p＜0.001) were statistically significant prognostic factors for overall survival.
Conclusion: We concluded that the pathological specimens with regional lymph node involvement in the patient receiving preoperative CRT is a strongly prognostic factor for overall survival. Advanced clinical T stage and bulky tumor (≥4cm) noted at surgical resection are also associated with poor overall survival. Further prospective studies which enroll more patients to evaluate the impact of pathologic lymph node status and to define the optimal management are warranted.

並列關鍵字

Rectal cancer ； Preoperative chemoradiotherapy ； Prognostic factors