Five-year Treatment Outcomes for Stage II to III Rectal Cancer in a Single Cancer Institution
KC Lee, ATY Chang, ALY Law, LK Chan, HYS Cheung, WT Ng
Hong Kong J Radiol 2014;17:255-66
DOI: 10.12809/hkjr1414235
Objective: This study aimed to find out the survival and recurrence rates following curative treatments for stage II and III rectal adenocarcinoma.
Methods: Between 1 January 2002 and 31 December 2007, 344 patients with stage II or III rectal cancer treated with curative intent were retrospectively reviewed in our institution. Treatment methods, survival outcomes, and the patterns of failure were analysed.
Results: Among this patient cohort, 193 patients received total mesorectal excision (TME) surgery and 146 had non-TME surgery. Of the patients, 83 underwent neoadjuvant radiotherapy or chemoradiotherapy, whereas 261 received surgery without neoadjuvant treatment. The overall survival rate and local recurrence rate of the entire group at 5 years was 66.1% and 14.4%, respectively. Patients with TME surgery had significantly lower local recurrence rate (9.7%) than those with non-TME surgery (20.1%; p = 0.01). There was a trend for superior 5-year overall survival (70.6% vs. 61.9%; p = 0.09). The 5-year disease-free survival (61.4% vs. 48.2%; p = 0.025) was significantly improved in the TME versus non-TME groups. Clear surgical margins and the use of adjuvant therapy were associated with better overall survival. Routine preoperative local staging of patients was inadequate, with only 31.7% of patients having received endorectal ultrasound or pelvic magnetic resonance imaging before operation.
Conclusion: Increased adoption of TME surgery, clear surgical margins, and the use of adjuvant therapy are important factors for improving the treatment outcomes for stage II and III rectal cancer. An adequate preoperative local staging is also recommended.
中文摘要
單中心二、三期直腸癌五年治療結果報導
李建忠、張天怡、羅麗柔、陳麗君、張睿珊、吳偉棠
目的：探討二、三期直腸腺癌根治性治療的生存率和復發率。
方法：回顧性分析2002年1月1日至2007年12月31日本中心二、三期直腸癌根治性治療，患者共344例。分析其治療方法、生存結果和失敗模式。
結果：患者中，193例進行全直腸系膜切除術（TME），146例未行TME；83例接受新輔助放療或放化療，261例行單純手術，未接受新輔助治療。全組五年總生存率和局部復發率分別為66.1%和14.4%。接受TME的患者局部復發率明顯降低（TME組9.7%，非TME組20.1%，p = 0.01）。接受TME的患者五年總生存率有提高的趨勢（TME組70.6%，非TME組61.9%，p = 0.09），五年無病生存率也明顯改善（TME組61.4%，非TME組48.2%，p = 0.025）。手術切緣淨和輔助治療可提高總生存率。患者術前的常規局部分期不足，僅31.7%的患者術前曾接受直腸內超聲或盆腔磁共振成像檢查。
結論：推廣TME、手術切緣淨及聯合輔助治療是提高二、三期直腸腺癌療效的重要因素。建議完善術前局部分期。