| Objective:The standard treatment for locally advanced rectal cancer is neoadjuvant therapy followed by surgery and adjuvant therapy,but neoadjuvant therapy does not significantly improve DFS and OS(compared with postoperative chemoradiotherapy).The Chinese people have not yet fully accepted the neoadjuvant treatment of rectal cancer.Adjuvant chemotherapy combined with radiotherapy has still been used in some patients with locally advanced rectal cancer.As rectal length is highly variable,there is a difference in the length of rectum between Asian people and European and American people.There may be differences in the benefits of whole pelvic radiotherapy in patients with rectal cancer from different sites and populations,The purpose of this study was to explored the effect of different demarcation markers on postoperative radiotherapy in locally advanced rectal cancer.Methods:From January 2011 to December 2013,a total of 234 patients with rectal cancer were enrolled in Tianjin Medical University Cancer Hospital.Among them,patients who were all pathologically diagnosed with adenocarcinoma and underwent radical surgical resection were selected as subjects for retrospective analyses,and the clinical and pathological data were collected.Moreover,all patients had underwent colonoscopy before surgery.Surgical records clearly described the relationship between tumor and peritoneal reflection,and postoperative pathological diagnoses were staged II/III.We used 3-year DFS as the primary endpoint,and 3-year LRFS,3-year DMFS as a secondary endpoint.DFS was defined as the period from the first postoperative day up to the first observation of disease progression or death from any cause,LRFS was defined as the period from the first postoperative day up to the first observation of disease progression.DMFS was defined as the period from the first postoperative day up to the first observation of disease distant metastasis.SPSS 17.0statistical software was used for statistical analysis.The prognostic factors were compared by Kaplan-Meier survival analysis and Log-rank test.Enumeration data and efficacy comparison using X2 test or Fisher exact probability method.Results:A total of 234 patients were included in the study.There were a total of 71 cases with rectal cancer up the peritoneum reflection,and a total of 163 cases with rectal cancer below the peritoneum reflection.There were a total of 212 cases ofrectal cancer which tumors with inferior borders?10cm from the anal verge,and a total of 22 cases of rectal cancer,s inferior borders>10cm from the anal verge.The mean lengths of the peritoneal reflection were(7.79±2.71)cm(Range,4cm-15cm)in rectal cancer of Chinese people.Treatment modality(postoperative adjuvant chemoradiotherapy,postoperative chemotherapy,postoperative without treatment)as a stratification factor,there was no significant difference between the group of tumors with inferior borders?8cm from the anal verge and the group of tumors with inferior borders?10cm from the anal verge in the 3-year local LRFS,the 3-year local LRFS in the chemoradiotherapy group was better than in the chemotherapy group.the group of tumors with inferior borders bwteen 8cm and10 cm from the anal verge in the 3-year local LRFS,the 3-year local LRFS in the chemotherapy group was better than in the chemoradiotherapy group.the group of tumors with inferior borders 8cm-10 cm from the anal verge might not benefited from the postoperative adjuvant chemoradiotherapy.there was no significant difference between extraperitoneal group and the group of tumors with inferior borders?8cm from the anal verge in the 3-year local LRFS in conditions of different treatments(postoperative adjuvant chemoradiotherapy,postoperative chemotherapy,postoperative without treatment),the 3-year local LRFS in the chemoradiotherapy group was better than in the chemotherapy group.there was no significant difference between intraperitoneal group and the group of tumors with inferior borders>8cm from the anal verge in conditions of different treatments in the 3-year local LRFS,the 3-year local LRFS in the chemotherapy group was better than in the chemoradiotherapy group.The 3-year local LRFS in the radical surgery patients with stage III rectal cancer in the group of tumors with inferior borders?8cm from the anal verge in chemotherapy was better than in chemoradiotherapy.Hawever,radical surgery patients with stage III rectal cancer in extraperitoneal group the 3-year local LRFS in the chemoradiotherapy group was better than in the chemotherapy group.It might be suggested that the peritoneal reflection,which was better than the 8cm from the anal verge,should be used to assess the efficacy of adjuvant radiotherapy for rectal cancer.Conclusion:The distance from the inferior borders of rectal cancer located at the peritoneal reflection to the anal verge rectal cancer was(7.79±2.71)cm(range,4cm-15cm).Based on the different of human anatomy,we recommend that the Chinese people take the peritoneal reflection as a demarcation line of adjuvant radiotherapy for rectalcancer. |
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