医学
全直肠系膜切除术
结直肠癌
危险系数
放化疗
置信区间
比例危险模型
回顾性队列研究
腺癌
肿瘤科
内科学
外科
癌症
作者
M. Collard,Eric Rullier,Yves Panis,Mehdi Karoui,Stéphane Benoist,Jean-Jacques Tuech,Arnaud Azevêdo Alves,Anais Laforest,Diane Mege,Antoine Cazelles,Laura Beyer-Berjot,Niki Christou,Eddy Cotte,Jérémie H. Lefevre,Lauren A. O’Connell,Yann Parc,Guillaume Piessen,Jérémie H. Lefevre
出处
期刊:Surgery
[Elsevier]
日期:2022-01-01
卷期号:171 (5): 1193-1199
标识
DOI:10.1016/j.surg.2021.10.003
摘要
A better understanding of pathological features and oncological survival in ypT0 rectal cancer after neoadjuvant chemoradiotherapy is required to improve patient selection criteria for rectal-preserving approach by local excision. Our aim was to define risk of lymph node metastasis and oncological outcomes in ypT0 rectal cancer after chemoradiotherapy and total mesorectal excision.All consecutive patients who underwent total mesorectal excision for a nonmetastatic rectal adenocarcinoma classified ypT0 after neoadjuvant chemoradiotherapy, with or without locoregional lymph node involvement (ypN+ or ypN-), in 14 French academic centers between 2002 and 2015 were included. Data were collected retrospectively. Overall and disease-free survival were explored.Among the 383 ypT0 patients, 6% were ypN+ (23/283). Before chemoradiotherapy, 86% (327/380) were staged cT3-T4 and 41% (156/378) were staged cN+. The risk of ypN+ did not differ between cT3-T4 and cT1-T2 patients (P = .345) or between cN+ and cN- patients (P = .384). After a median follow-up of 61.1 months, we observed 95% confidence interval (92%-97%) of 5-year overall survival and 93% confidence interval (91%-96%) of 5-year disease-free survival. In Cox multivariate analysis, overall survival was altered by intra-abdominal septic complications (hazard ratio = 2.53, confidence interval [1.11-5.78], P = .028). Regarding disease-free survival, ypN+ status and administration of adjuvant chemotherapy were associated with a reduced disease-free survival (P = .001 for both). cT3/T4 staging and cN+ staging did not modify overall survival (P = .332 and P = .450) nor disease-free survival (P = .862 and P = .124).The risk of lymph node metastasis and the oncological survival do not depend on the initial cT or cN staging in cases of ypT0 complete rectal tumor regression.
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