背景:尽管进行了多模式治疗,但接受晚期直肠癌(LARC)切除术的患者中有5-15%会出现局部复发。局部复发性直肠癌(LRRC)的管理提出了重大的治疗挑战,即使是现代切除术,5年生存率为25-50%。该队列中局部和全身复发率高反映了这些肿瘤类型可能的生物学侵袭性。这篇综述旨在评估目前的文献,以确定与手术切除患者的生存和肿瘤复发相关的病理因素。
方法:对MEDLINE进行了系统评价,根据PRISMA指南,从2010年到2021年7月,评估影响LARC或LRRC盆腔切除术后生存的病理因素的所有研究的EMBASE和COCHRANE试验数据库。使用QUIPS工具评估偏倚风险。
结果:9项队列研究符合纳入标准,报告2864例患者的结果。由于报告结果的显著异质性,无法进行荟萃分析。切除边缘状态和淋巴结疾病是最常见的报告因素。在六项研究中,阳性切除切缘被证明是阴性预后指标。涉及的淋巴结和淋巴管浸润似乎也是负面的预后标志物,肿瘤分期不太重要。没有研究评估其他不良肿瘤特征,否则不会包括在标准组织病理学报告中。
结论:病理切缘状态被广泛证明会影响直肠癌盆腔切除术后的无病生存和总生存。随着R0率的增加,必须探索其他不良肿瘤特征,以帮助阐明生存率的差异,并可能指导量身定制的肿瘤治疗。
BACKGROUND: Despite multimodal therapy 5-15% of patients who undergo resection for advanced rectal cancer (LARC) will develop local recurrence. Management of locally recurrent rectal cancer (LRRC) presents a significant therapeutic challenge and even with modern exenterative surgery, 5-year survival rates are poor at 25-50%. High rates of local and systemic recurrence in this cohort are reflective of the likely biological aggressiveness of these tumour types. This
review aims to appraise the current literature identifying pathological factors associated with survival and tumour recurrence in patients undergoing exenterative surgery.
METHODS: A systematic
review was carried out searching MEDLINE, EMBASE and COCHRANE Trials database for all studies assessing pathological factors influencing survival following pelvic
exenteration for LARC or LRRC from 2010 to July 2021 following PRISMA guidelines. Risk of bias was assessed using QUIPS tool.
RESULTS: Nine cohort studies met inclusion criteria, reporting outcomes for 2864 patients. Meta-analysis was not possible due to significant heterogeneity of reported outcomes. Resection margin status and nodal disease were the most commonly reported factors. A positive resection margin was demonstrated to be a negative prognostic marker in six studies. Involved lymph nodes and lymphovascular invasion also appear to be negative prognostic markers with tumour stage to be of lesser importance. No studies assessed other adverse tumour features that would not otherwise be included in a standard histopathology report.
CONCLUSIONS: Pathological resection margin status is widely demonstrated to influence disease free and overall survival following pelvic
exenteration for rectal cancer. With increasing R0 rates, other adverse tumour features must be explored to help elucidate differences in survival and potentially guide tailored oncological treatment.