Objective To evaluate the value of adjuvant radiotherapy after radical resection for pT3N0 rectal cancer. Methods The clinical data of 125 patients with pT3N0 rectal cancer who were diagnosed and given total mesorectal excision in our hospital from 2003 to 2010 were retrospectively analyzed. All patients received postoperative adjuvant chemotherapy, while 40 out of them received postoperative adjuvant radiotherapy in addition. Survival rates were estimated using the Kaplan-Meier method, and univariate prognostic analysis was performed using the log-rank test. Multivariate analysis of influencing factors for local recurrence (LR) rate was performed using the Cox regression model. Results The 5-year sample size was 35. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 72.4%, respectively. There was no significant difference in the 5-year OS rate between the postoperative chemoradiotherapy group and the postoperative chemotherapy group (72% vs. 83%, P=0.911). Multivariate analysis suggested that the number of lymph nodes and perirectal fat infiltration were independent prognostic factors for LR rate (P=0.045;P=0.021). There was no significant difference in LR rate between the low-risk group (no high-risk factors) and the high-risk group (the number of high-risk factors ≥1)(2.5% vs. 11.8%, P=0.060). Conclusions Postoperative radiotherapy cannot improve the OS and LR rates for pT3N0 rectal cancer without any high-risk factors. The value of postoperative adjuvant radiotherapy for pT3N0 rectal cancer needs further evaluation.
[1] The Gastrointestinal Tumor Study Group. Radiation therapy and fluorouracil with or without semustine for the treatment of patients with surgical adjuvant adenocarcinoma of the rectum[J]. J Clin Oncol,1992,10(4):549-557. [2] DouglassHO Jr, Moertel CG, Mayer RJ, et al. Survival after postoperative combination treatment of rectal cancer[J]. N Engl J Med,1986,315(20):1294-1295. [3] Zoccali M,Fichera A.Role of radiation in intermediate-risk rectal cancer[J].Ann Surg Oncol,2012,19(1):126-130.DOI:10.1245/s10434-011-1849-2. [4] 万德森.直肠癌外科治疗的进展[J].中国癌症杂志,2006,16(10):767-768. [5] Leong AF. Selective total mesorectal excision for rectal cancer[J].Dis Colon Rectum,2000,43(9):1237-1240. [6] MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer[J]. Lancet,1993,341(8843):457-460. [7] de Haas-Kock DF, Baeten CG, Jager JJ, et al. Prognostic significance of radial margins of clearance in rectal cancer[J]. Br J Surg,1996,83(6):781-785. [8] Havenga K, Enker WE, Norstein J, et al. Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer:an international analysis of 1411 patients[J]. Eur J Surg Oncol,1999,25(4):368-374. [9] Zhu J,Xu Y,Gu W,et al. Adjuvant therapy for T3N0 rectal cancer in the total mesorectal excision era-identification of the high risk patients[J/OL]. Radiat Oncol,2010,5:118[2014-10-20].http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009675/.DOI:10.1186/1748-717X-5-118. [10] Gunderson LL, Sargent DJ, Tepper JE, et al. Impact of T and N stage and treatment on survival and relapse in adjuvant rectal cancer:a pooled analysis[J].J Clin Oncol,2004,22(10):1785-1796. [11] Enker WE, Thaler HT, Cranor ml, et al. Total mesorectal excision in the operative treatment of carcinoma of the rectum[J]. J Am Coll Surg,1995,181(4):335-346. [12] Park IJ, Kim HC, Yu CS, et al. Effect of adjuvant radiotherapy on local recurrence in stage Ⅱ rectal cancer[J]. Ann Surg Oncol,2008,15(2):519-525. [13] Merchant NB, Guillem JG, Paty PB, et al. T3N0 rectal cancer:results following sharp mesorectal excision and no adjuvant therapy[J]. J Gastrointest Surg,1999,3(6):642-647. [14] Willett CG, Badizadegan K, Ancukiewicz M, et al. Prognostic factors in stage T3N0 rectal cancer:do all patients require postoperative pelvic irradiation and chemotherapy?[J]. Dis Colon Rectum,1999,42(2):167-173. [15] Picon AI, Moore HG, Sternberg SS, et al. Prognostic significance of depth of gross or microscopic perirectal fat invasion in T3N0M0 rectal cancers following sharp mesorectal excision and no adjuvant therapy[J]. Int J Colorectal Dis,2003,18(6):487-492. [16] Kim JS, Kim NK, Min BS, et al. Adjuvant radiotherapy following total mesorectal excision for stage ⅡA rectal cancer:is it beneficial?[J]. Int J Colorectal Dis,2010,25(9):1103-1110.DOI:10.1007/s00384-010-0970-1. [17] Park IJ, Kim HC, Yu CS, et al. Effect of adjuvant radiotherapy on local recurrence in stage Ⅱ rectal cancer[J].Ann Surg Oncol,2008,15(2):519-525.DOI:10.1245/s10434-007-9643-x. [18] Tepper JE, O Connell MJ, Niedzwiecki D, et al. Impact of number of nodes retrieved on outcome in patients with rectal cancer[J]. J Clin Oncol,2001,19(1):157-163. [19] Greco P, Andreola S, Magro G, et al. Potential pathological understanding of pT3 rectal cancer with less than 26 lymph nodes recovered:a prospective study based on a resampling of 50 rectal specimens[J]. Virchows Arch,2006,449(6):647-651.DOI:10.1007/s00428-006-0313-3. [20] Folkesson J, Birgisson H, Pahlman L, et al. Swedish rectal cancer trial. Long lasting benefits from radiotherapy on survival and local recurrence rate[J]. J Clin Oncol,2005,23(24):5644-5650.DOI:10.1200/jco.2005.08.144. [21] Faerden AE, Naimy N, WⅡk P, et al. Total mesorectal excision for rectal cancer. difference in outcome for low and high rectal cancer[J]. Dis Colon Rectum,2005,48(12):2224-2231.
2015, Vol. 24 
