Worse Survival in Rectal Cancer Patients with Preoperative Radiotherapy Compared to without Radiotherapy in Same Postoperative Pathologic pN1 Classification

在術後病理同為pN1分類之直腸癌患者中，接受術前放射線治療者比未接受族群，其生存其明顯較差

許祐仁(Yu-Jen Hsu) ； 蔡文司(Wen-Sy Tsai) ； 謝寶秀(Pao-Shiu Hsieh) ； 葉建裕(Chien-Yuh Yeh) ； 游正府(Jeng-Fu You) ； 洪欣園(Hsin-Yuan Hung) ； 蔣昇甫(Sum-Fu Chiang) ； 賴正洲(Cheng-Chou Lai) ； 游耀東(Yau-Tong You) ； 江支銘(Jy-Ming Chiang) ； 唐瑞平(Rei-Ping Tang) ； 張簡俊榮(Chung-Rong Chang Chien) ； 陳進勛(Jinn-Siun Chen)

《中華民國大腸直腸外科醫學會雜誌》 27卷1期 (2016/03) Pp. 7-14

https://doi.org/10.6312/SCRSTW.2016.27(1).10414

摘要

目的：本篇文章比較直腸癌術前接受和不接受放射線治療的兩組病患，分析評估其病理特徵及預後變化。方法：挑選2002年到2007年間原發直腸癌接受根治性切除的新發病例。共1544個病患，其中包括239個病患術前接受放療。結果：病理特徵變化方面，術前有接受放療比沒接受放療之患者其小體積腫瘤、潰瘍形態和分化不良之腫瘤比率較高(均p ＜ 0.05)。患者術前有接受與無接受放療比較，其復發率、3年無病率及5年癌症特異生存率，在pT4之腫瘤分別為60.0與42.8% (p =0.04)，45.0與59.7%(p = 0.04)和47.6與64.3%(p = 0.056)；在pN1之腫瘤，分別為48.1與30.7%(p = 0.01)，52.8與72.9%(p ＜ 0.01)和51.8與75.1%(p = 0.03)。術後病理為pN1之直腸癌患者，術前接受放療比無放療的群組生存期明顯較差。放療與否在pN0和pN2組的預後則無差異性。術前未接受放療的病患，pN2明顯比pN1存活率較差，但在術前接受放療的病患，無病率和癌症特異性生存率在ypN1和ypN2之間則沒有顯著差異。結論：術前放射治療直腸癌病患的腫瘤分期降階使長期生存有好的影響。但我們的研究顯示，術前放療若最終病理報告為ypN1，則病人比未放療之pN1有較差的存活率，這可能導因癌細胞特性的改變或放療反應不足無法顯示出改善存活率之益處。有必要進一步的研究來更精確地選擇合適的病人接受術前放療。

關鍵字

直腸惡性腫瘤 ； 術前放射治療 ； 病裡特徵 ； 存活率

並列摘要

Purpose. In this study, we compared the rectal cancer patients with and without preoperative radiotherapy, to evaluate the change of pathologic characteristics and prognosis. Patients and Methods. From 2002 to 2007, the cases of primary rectal cancer and receiving curative resection were selected. Totally, there were 1544 cases including 239 cases preoperative radiotherapy enrolled. Results. After preoperative radiotherapy, the significant change of pathologic characteristics included more percentage of smaller tumor size, ulcerative morphologic type and poor differentiation histological grade in patients with preoperative RT than those of not (all p ＜ 0.05). The recurrent incidence, 3-year disease-free and 5-year cancer-specific survival rates of patients with preoperative radiotherapy vs. no radiotherapy were 60.0 vs. 42.8% (p = 0.04), 45.0 vs. 59.7% (p = 0.04) and 47.6 vs. 64.3% (p = 0.056) in pT4 patients, and were 48.1 vs. 30.7% (p = 0.01), 52.8 vs. 72.9% (p ＜ 0.01) and 51.8 vs. 75.1% (p = 0.03) in pN1 patients, respectively. After curative resection of tumor, the prognosis of pN1 patients with preoperative radiotherapy was worse than those without radiotherapy. There was no difference in survival rate of pN0 and pN2 classification between the patients with and without preoperative RT. Conclusion. Downstage effect of preoperative RT has beneficial impact on long term survival of patients with rectal cancer, but our findings showed that the worse survival rates of pathologic ypN1 classification of patients with preoperative RT then pathologic pN1 classification without preoperative RT. This may be resulted from change of characteristics of cancer cell behavior or insufficient response to show benefits. Further study is necessary to more precisely select suitable patients for receiving preoperative RT.

並列關鍵字

Rectal cancer ； Preoperative radiotherapy ； Pathologic characteristics ； Survival

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