Ann Surg：术前放化疗不增加直肠癌吻合口瘘风险

在过去十年间，对于术前CRT对AL的影响，相关数据彼此矛盾。对此，韩国延世大学的Woong Sub Koom博士等人进行了一项研究，该研究通过倾向性评分匹配法，评价了在直肠癌切除术前进行的放化疗(CRT)对术后吻合口瘘的影响。这项研究结果发表于2013年4月17日在线出版的《外科学年鉴》(Annals of Surgery)杂志上。最终通过倾向性评分匹配分析发现，术前CRT并未增加接受LAR治疗的直肠癌患者的术后AL风险。

研究人员研究针对自2005年至2012年期间，在延世大学癌症中心接受低位前切除(LAR)治疗的1437例直肠癌连续患者进行了考察。根据2010年由直肠癌国际研究组推荐的标准，该研究将C级AL评价结果定为主要终点。参试患者接受(n = 360)或不接受(n = 1077)术前CRT治疗。28个放疗分割的总剂量为50.4 Gy。最后通过多变量分析及倾向性评分匹配分析，对某些基线特征间的差异进行了补偿。

研究发现，与非术前CRT组相比，在术前CRT组中，含以下特征的患者较多：高龄、男性、吸烟者、晚期肿瘤、低位/中位直肠肿瘤部位、超低位前切除以及造口(所有P<0.05)。91例(6.3%)患者出现术后AL。在进行倾向性评分匹配之前，接受或不接受术前CRT治疗患者的AL发生率分别为7.5%及5.9%(P=0.293)。而倾向性评分匹配后，除初始分期及外科医师从业时间外，两组间各参数接近平衡，接受不接受术前CRT治疗患者的AL发生率分别为7.5%及8.1%,(P = 0.781)。

与直肠癌相关的拓展阅读：

• JCO：肿瘤生长时间可作为结直肠癌患者总生存率预测较佳指标
• JCO：结直肠癌患者生存率预测新指标
• Sleep：睡眠过多或致结直肠癌风险升高
• Gut：常见遗传变异对结直肠癌风险具有累积影响
• Radiother Oncol：5*5Gy方案和50.4Gy方案治疗不可手术的直肠癌患者无显著差异
• Ann Surg.：PET与CT均不宜预测放化疗前后直肠癌患者缓解情况
更多信息请点击：有关直肠癌更多资讯

Preoperative Chemoradiotherapy Effects on Anastomotic Leakage After Rectal Cancer Resection: A Propensity Score Matching Analysis.
OBJECTIVE
To assess the effects of preoperative chemoradiotherapy (CRT) on anastomotic leakage (AL) after rectal cancer resection, using propensity score matching.
BACKGROUND
Conflicting data have emerged over the last decade regarding the effect of preoperative CRT on AL.
METHODS
We reviewed 1437 consecutive patients with rectal cancer who underwent low anterior resection (LAR) at our institution between 2005 and 2012. AL evaluated as grade C was the primary endpoint, as proposed by the International Study Group of Rectal Cancer in 2010. The patients were treated with (n = 360) or without (n = 1077) preoperative CRT. The total radiation dose was 50.4 Gy in 28 fractions. Multivariate and propensity score matching analyses were used to compensate for the differences in some baseline characteristics.
RESULTS
The preoperative CRT group contained more patients with the following characteristics, older age, male sex, smoker, advanced stage tumor, lower/mid rectal tumor location, ultra-LAR, and diverting stoma, than the non-preoperative CRT group (all Ps < 0.05). Postoperative AL occurred in 91 patients (6.3%). Before propensity score matching, the incidence of AL in patients with or without preoperative CRT was 7.5% and 5.9%, respectively (P = 0.293). After propensity score matching, the 2 groups were nearly balanced except for the initial stage and the length of the surgeon's career, and the incidence of AL in patients with or without preoperative CRT was 7.5% and 8.1%, respectively (P = 0.781).
CONCLUSIONS
We did not observe that preoperative CRT increased the risk of postoperative AL after LAR in patients with rectal cancer, using propensity score matching analysis.