The Improvements of Outcomes in Stage II-III, Middle and Lower Third Rectal Cancer Patients in Recently Ten Years: The Improvements are Associated with Neo-adjuvant Concurrent Chemo-radiotherapy

近十年來第二、三期中低位直腸癌患者治療的結果有進步－此進步與術前化放療相關

陳建信(Chien-Hsin Chen) ； 林恩光(En-Kwang Lin) ； 盧延榕(Yen-Jung Lu) ； 魏柏立(Po-Li Wei)

《中華民國大腸直腸外科醫學會雜誌》 29卷1期 (2018/03) Pp. 64-71

https://doi.org/10.6312/SCRSTW.2018.29(1).10626

摘要

Purpose. We investigated survival and local recurrence in stage II-III, middle and lower third rectal cancer patients who underwent total mesorectal excision (TME) in recently ten years. Methods. Medical records from January 1999 to December 2011 were reviewed and 103 patients with stage II-III, middle and lower third rectal cancer (lower margin of tumor within 0-11 cm from anal verge) who received potentially curative resection, were identified. We divided the patients into two groups: Group1 patients from January 1999 to December 2006, and Group 2 patients from January 2007 to December 2011. We analyzed the clinical and oncological data from those patients. Results. The 5-year overall survival (OS), and local recurrence (LR) rates were 59%, and 16%, respectively in Group 1. The 5-year OS and LR rates were 76% and 6%, respectively in Group 2. The patients in Group 2 had better 5-year overall survival rate than Group 1 statistically significant (p = 0.023). The patients in Group 2 had lower local recurrence rate than Group 1, but not statistically significant (p = 0.0547). The sphincter preservation rate increased from 65% to 94% between two groups. The patients in Group 2 had better sphincter preservation rate (p = 0.002). The patients in Group 2 had undergone neo-adjuvant concurrent chemo-radiotherapy (CCRT) more frequently than Group 1 (p = 0.0001). So, the improvements are associated with neo-adjuvant CCRT. Conclusions. In this study, the patients in Group 2 had better outcomes than Group 1 including 5-year OS, 5-year LR and sphincter preservation rate. The improvements of outcomes were found in patients with stage II-III, middle and lower third rectal cancers who underwent TME in recently ten years. The improvements are associated with neo-adjuvant CCRT.

關鍵字

Rectal cancer ； Total meso-rectal excision ； Selective neoadjuvant concurrent chemo-radiotherapy

並列摘要

目的：我們探查近十年來第二、三期直腸癌患者接受全直腸繫膜切除(Total mesorectal excision)後之局部復發率及存活率。方法：我們回顧西元1999年1月至2011年12月期間的病歷記錄，共有103位病患符合下列標準：腫瘤下緣位於距肛門口11公分內，接受根治性切除手術者及第二、三期的直腸癌病患。我們將其分為兩群：第一群為西元1999年1月至2006年12月。第二群為西元2007年01月至2011年12月。我們分析他們的臨床資料，包括局部復發及存活率等。結果：第一群病患5年存活率(Overall survival rate)及5年局部復發率為59%及16%。第二群為76%及6%。明顯的發現第二群病患有較佳之5年存活率達統計學差異(p值為0.023)，第二群病患也有較低之5年局部復發率，但未達統計學差異(p值為0.0547)。第二群病患同時有較佳的肛門保存率(從65%至94%)(p值為0.002)。第二群病患有較高比率接受術前化放療(p值為0.0001)。因此，上述治療結果的進步與術前化放療相關。結論：第二群病患有較佳的5年存活率、肛門保存率及較低之5年局部復發率，近十年來第二、三期中低位直腸癌患者之治療有改善。上述之改善與術前化放療相關。

並列關鍵字

直腸癌 ； 全直腸繫膜切除 ； 選擇性術前同步化學放射治療

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