Risk factors for local recurrence in patients with clinical stage II/III low rectal cancer: A multicenter retrospective cohort study in Japan

被引：2

作者：

Kozu, Takumi ^{[1
]}

Akiyoshi, Takashi ^{[1
,2
]}

Sakamoto, Takashi ^{[1
]}

Yamaguchi, Tomohiro ^{[1
,2
]}

Yamamoto, Seiichiro ^{[3
]}

Okamura, Ryosuke ^{[4
]}

Konishi, Tsuyoshi ^{[5
]}

Umemoto, Yoshihisa ^{[4
]}

Hida, Koya ^{[4
]}

Naitoh, Takeshi ^{[6
]}

机构：

[1] Japanese Fdn Canc Res, Canc Inst Hosp, Gastroenterol Ctr, Dept Colorectal Surg, 3-8-31 Ariake,Koto ku, Tokyo 1358550, Japan

[2] Japanese Fdn Canc Res, Canc Inst Hosp, Rectal Canc Multidisciplinary Treatment Ctr, 3-8-31 Ariake,Koto ku, Tokyo 1358550, Japan

[3] Tokai Univ, Dept Gastroenterol Surg, Sch Med, Hiratsuka, Kanagawa, Japan

[4] Kyoto Univ, Grad Sch Med, Dept Surg, Kyoto, Japan

[5] Univ Texas MD Anderson Canc Ctr, Dept Colon & Rectal Surg, Houston, TX USA

[6] Kitasato Univ, Dept Lower Gastrointestinal Surg, Sch Med, Sagamihara, Kanagawa, Japan

来源：

ANNALS OF GASTROENTEROLOGICAL SURGERY | 2025年 / 9卷 / 01期

关键词：

lateral lymph node dissection; local recurrence; low rectal cancer; neoadjuvant treatment; BODY-MASS INDEX; TOTAL MESORECTAL EXCISION; PREOPERATIVE CHEMORADIOTHERAPY; OPEN-LABEL; FOLLOW-UP; IMPACT; RADIOTHERAPY; CHEMOTHERAPY; TME;

D O I：

10.1002/ags3.12849

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

BackgroundIdentifying risk factors for local recurrence (LR) is pivotal in optimizing rectal cancer treatment. Total mesorectal excision (TME) and lateral lymph node dissection (LLND) are the standard treatment for advanced low rectal cancer in Japan. However, large-scale studies to evaluate risk factors for LR are limited.MethodsData from 1479 patients with clinical stage II/III low rectal cancer below the peritoneal reflection, surgically treated between January 2010 and December 2011 across 69 hospitals, were analyzed. Fine-Gray multivariable regression modeling was used to identify risk factors associated with LR. Two models were developed: one using preoperative factors only, and the other incorporating operative and postoperative factors.ResultsAcross the entire cohort, the 5-year cumulative incidence of LR was 12.3% (95% confidence interval, 10.7-14.1). The multivariable analysis associated LR with various preoperative (body mass index, distance from anal verge, cN category, and histological subtype), treatment-related (neoadjuvant therapy, and LLND), and postoperative (pT, pN, and resection margins) risk factors. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (body mass index >= 25 kg/m2, distance from anal verge <= 4.0 cm, non-well/moderately differentiated adenocarcinoma). The 5-year cumulative incidence of LR was 24.7% in patients treated without LLND and 22.9% in patients treated with LLND.ConclusionThis large multicenter cohort study identified some risk factors for LR in the setting where upfront TME was predominant, offering insights to optimize rectal cancer treatment. In this multicenter cohort study, we examined preoperative and postoperative risk factors for LR after low rectal cancer surgery. For patients without neoadjuvant treatment, LR risk was unacceptably high with two or three preoperative risk factors (BMI, distance from anal verge, histological subtype).image

引用

页码：128 / 136

页数：9

共 32 条

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