[Study on the recurrence pattern of rectal cancer patients undergoing radical surgery after neoadjuvant chemoradiotherapy].

Objective: To analyze the recurrence pattern of rectal cancer patients with radical surgery after neoadjuvant chemoradiotherapy. Methods: The clinicopathological characteristics and follow-up information of rectal cancer patients with radical surgery after neoadjuvant chemoradiotherapy in the Cancer Hospital of the Chinese Academy of Medical Sciences from June 2004 to December 2017 were retrospectively collected. The recurrence pattern including the time and site was investigated. Results: The age of 537 patients was (55.5±11.7) years, of whom 361 were male (67.2%). The median follow-up time [M(Q1,Q3)] was 77.9 (64.5, 95.6) months. Moreover, 30.7% (165/537) of patients had distant metastasis or local recurrence; 26.8% (144/537) of patients had distant metastasis; 5.6% (30/537) of patients had local recurrence; 1.7% (9/537) of patients had both distant metastasis and local recurrence. In all the recurrent patients, 23.6% (39/165) were in the first year after surgery, followed by 27.3% (45/165) in the second year, 17.0% (28/165) in the third year, and 15.8% (26/165) after five years. According to the risk curve drawn by the life table, the highest metastasis risk of patients occurred in the second year after surgery, and the metastasis risk peak occurred again after more than five years. The lung was the most common metastatic organ, accounting for 47.9% (69/144), followed by the liver (18.8%, 27/144). The ratios of the recurrent patients in each ypTNM stage were 9.5% (8/84), 12.0% (12/100), 26.5% (41/155), 52.5% (104/198), respectively. The proportion of recurrent patients in tumor regression grade (TRG) 1-2 and TRG 3-5 patients were 19.2% (38/198) and 37.5% (127/339), respectively. Conclusions: The recurrence pattern of patients undergoing radical surgery after neoadjuvant chemoradiotherapy is mainly distant metastasis. The lung is the primary metastatic organ. The risk of distant metastasis and local recurrence is high in the first three years after surgery, and there is still high risk of recurrence after five years. For patients with ypTNM stage 2, 3 and TRG3-5, the postoperative adjuvant chemotherapy and long-term follow-up should be strengthened.目的： 分析直肠癌新辅助放化疗后根治性手术患者的复发情况。 方法： 回顾性收集2004年6月至2017年12月中国医学科学院肿瘤医院接受新辅助放化疗后行根治性手术的537例直肠癌患者的临床病理资料和随访数据，分析患者术后复发时间规律与部位特点。 结果： 537例患者的年龄为（55.5±11.7）岁，男性361例（67.2%）；随访时间［M（Q1，Q3）］为77.9（64.5，95.6）个月，随访时间内30.7%（165/537）的患者出现复发，其中26.8%（144/537）出现远处转移，5.6%（30/537）出现局部复发，同时存在远处转移与局部复发的有1.7%（9/537）。术后第1年复发的患者占23.6%（39/165），第2年占27.3%（45/165）（风险比=0.08），第3年占17.0%（28/165），5年后复发占15.8%（26/165）。患者远处转移的发生风险在术后第2年达高峰，随访超过5年后，仍存在远处转移的发生风险高峰。肺脏是首发转移比例最高的器官，占47.9%（69/144），其次为肝脏18.8%（27/144）。YpTNM分期患者的复发率分别为9.5%（8/84）、12.0%（12/100）、26.5%（41/155）、52.5%（104/198）。肿瘤退缩反应（TRG）1~2、3~5级患者复发率分别为19.2%（38/198）、37.5%（127/339）。 结论： 新辅助放化疗后行根治性手术的直肠癌患者以远处转移为主，肺脏是主要首发转移器官，术后前3年复发风险高，随访5年后仍有较高的复发风险，对ypTNM 2、3期、TRG3~5级患者更应该加强术后辅助治疗和长期随访。.