수술 전 화학방사선치료에 병리학적 완전 관해를 보인 직장암 환자의 임상병리학적 특징 및 종양학적 결과
Pathologic Complete Remission after Preoperative Chemoradiation for Rectal Cancer: Analysis of Clinicopathologic Characteristics and Oncologic Outcome
김대동, 유창식, 신의섭, 윤상남, 김진천,
소속 상세정보
김대동 ( Kim Dae-Dong )
대구가톨릭대학교 의과대학 외과학교실
유창식 ( Yu Chang-Sik )
울산대학교 의과대학 서울중앙병원 외과학교실 대장항문클리닉
신의섭 ( Shin Ui-Sup )
울산대학교 의과대학 서울아산병원 외과학교실
윤상남 ( Yoon Sang-Nam )
울산대학교 의과대학 서울아산병원 외과학교실
김진천 ( Kim Jin-Cheon )
울산대학교 의과대학 서울아산병원 외과학교실
KMID : 0356720080240060473
Abstract
Purpose: To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR.
Methods: We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4∼6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12∼91) months.
Results: The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P=0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group.
Conclusions: Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.
키워드
수술 전 화학방사선요법;직장암;완전관해
Preoperative chemoradiotherapy;Rectal cancer;Complete remission
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