AIM: To evaluate whether an abdominoperineal excision(APE) is associated with increased local recurrence(LR) and shortened disease-free survival(DFS) in mid-low rectal cancer with a negative circumferential resection ...AIM: To evaluate whether an abdominoperineal excision(APE) is associated with increased local recurrence(LR) and shortened disease-free survival(DFS) in mid-low rectal cancer with a negative circumferential resection margin(CRM).METHODS: 283 consecutive cases of mid-low rectal cancer underwent preoperative 30 Gy/10 F radiotherapy and surgery in Peking University Cancer Hospital between August 2003 and August 2009. Patients with positive CRM and intraoperative distant metastasis were precluded according to exclusion criteria. Survival analyses were performed in patients with APE or non-APE procedures.RESULTS: 256 of the 283(90.5%) cases were enrolled in the analysis, including 78(30.5%) and 178(69.5%) cases who received APE and non-APE procedures. Fewer female patients(P = 0.016), lower level of tumor(P = 0.000) and higher body mass index(P = 0.006) were found in the APE group. On univariate analysis, the APE group had a higher LR rate(5.1% vs 1.1%, P = 0.036) and decreased DFS(73.1% vs 83.4%, P = 0.021). On multivariate analysis, APE procedure was also an independent risk factor for LR(HR = 5.960, 1.085-32.728, P = 0.040) and decreased DFS(HR = 2.304, 1.298-4.092, P = 0.004). In stratified analysis for lower rectal cancer, APE procedure was still an independent risk factor for higher LR rate(5.6% vs 0%, P = 0.024) and shortened DFS(91.5% vs 73.6%, P = 0.002).CONCLUSION: Following preoperative 30 Gy/10 F radiotherapy, APE procedure was still a predictor for LR and decreased DFS even with negative CRM. More intensive preoperative treatment should be planned for the candidates who are scheduled to receive APE with optimal imaging assessment.展开更多
Colorectal cancer has a high incidence, and approxi-mately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients(> 70-75 years of age) are a...Colorectal cancer has a high incidence, and approxi-mately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients(> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are underrepresented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.展开更多
基金Supported by Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(code ZY201410)
文摘AIM: To evaluate whether an abdominoperineal excision(APE) is associated with increased local recurrence(LR) and shortened disease-free survival(DFS) in mid-low rectal cancer with a negative circumferential resection margin(CRM).METHODS: 283 consecutive cases of mid-low rectal cancer underwent preoperative 30 Gy/10 F radiotherapy and surgery in Peking University Cancer Hospital between August 2003 and August 2009. Patients with positive CRM and intraoperative distant metastasis were precluded according to exclusion criteria. Survival analyses were performed in patients with APE or non-APE procedures.RESULTS: 256 of the 283(90.5%) cases were enrolled in the analysis, including 78(30.5%) and 178(69.5%) cases who received APE and non-APE procedures. Fewer female patients(P = 0.016), lower level of tumor(P = 0.000) and higher body mass index(P = 0.006) were found in the APE group. On univariate analysis, the APE group had a higher LR rate(5.1% vs 1.1%, P = 0.036) and decreased DFS(73.1% vs 83.4%, P = 0.021). On multivariate analysis, APE procedure was also an independent risk factor for LR(HR = 5.960, 1.085-32.728, P = 0.040) and decreased DFS(HR = 2.304, 1.298-4.092, P = 0.004). In stratified analysis for lower rectal cancer, APE procedure was still an independent risk factor for higher LR rate(5.6% vs 0%, P = 0.024) and shortened DFS(91.5% vs 73.6%, P = 0.002).CONCLUSION: Following preoperative 30 Gy/10 F radiotherapy, APE procedure was still a predictor for LR and decreased DFS even with negative CRM. More intensive preoperative treatment should be planned for the candidates who are scheduled to receive APE with optimal imaging assessment.
文摘Colorectal cancer has a high incidence, and approxi-mately 60% of colorectal cancer patients are older than 70, with this incidence likely increasing in the near future. Elderly patients(> 70-75 years of age) are a very heterogeneous group, ranging from the very fit to the very frail. Traditionally, these patients have often been under-treated and recruited less frequently to clinical trials than younger patients, and thus are underrepresented in publications about cancer treatment. Recent studies suggest that fit elderly patients can be treated in the same way as their younger counterparts, but the treatment of frail patients with comorbidities is still a matter of controversy. Many factors should be taken into account, including fitness for treatment, the wishes of the patient and family, and quality of life. This review will focus on the existing evidence for surgical, oncologic, and palliative treatment in patients over 70 years old with colorectal cancer. Careful patient assessment is necessary in order to individualize treatment approach, and this should rely on a multidisciplinary process. More well-designed controlled trials are needed in this patient population.
