Les facteurs pronostiques du cancer du rectum: quels sont les niveaux de preuve ?
Mots-clés :
cancer du rectum, pronostic, survie globale, survie sans récidive, evidence-based medicine.Résumé
survie à 5 ans du cancer du rectum est passée de 25% à près de 53 % tous stades confondus . Ce taux demeure encore faible, et ce malgré les progrès réalisés sur le plan diagnostique et thérapeutique.
Le but de notre travail était de répondre à la question : quels sont les facteurs pronostiques pré, per et post-opératoires du cancer du rectum, en se basant sur les règles de l’évidence-based medicine.
Méthodes :Nous avons réalisé une recherche bibliographique dans les bases dedonnées suivantes : Pubmed, Embase, Cochrane et Scopus. Les mots-clésutilisés étaient les suivants : «rectal cancer », « adenocarcinoma », « overallsurvival », « disease-free survival », « prognosis », « evidence-basedmedicine ». La survie globale à 5 ans a été retenue comme critère dejugement principal. La survie sans récidive a été retenue comme critère dejugement secondaire.Nous avons décidé de retenir les méta-analyses et les revues systématiquesdes essais cliniques ou de la littérature datant de moins de 6 ans.
Résultats : Nous avons retrouvé 270 publications, 27 articles répondant aux critères d’éligibilité sus-cités ont été retenus dans ce travail.Un volume opératoire élevé, la spécialisation en chirurgie colo-rectale,l’excision totale du mésorectum, une chimiothérapie adjuvante administréeau plus tard huit semaines après la chirurgie à vise curative, sont desfacteurs qui améliorent le pronostic dans le cancer du rectum avec un niveauI de preuve. Le lâchage anastomotique et le diabète aggravent le pronosticdu cancer du rectum avec un niveau I de preuve. Les marges de résection doivent être RO afin d’améliorer le pronostic du cancer du rectum avec un niveau I de preuve.
Conclusion: Les principaux facteurs pronostiques rapportés dans la littérature et qui doivent être retenus sont ceux sur lesquels le chirurgien peut agir, à savoir:le traitement néoadjuvant, le volume opératoire élevé, une ligature haute del’artère mésentérique inférieure, l’excision totale du mésorectum, la résection RO, l’amélioration des techniques de résection inter-sphinctérienne et des techniques anastomotiques ainsi qu’une chimiothérapie adjuvante qui doit être administrée au plus tard huit semaines après la résection si elle est indiquée.
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Références
Torre LA, Bray F, Siege RL et al. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108.
Arfa N et al. Survie et facteurs pronostiques des adénocarcinomes colorectaux : étude analytique uni et multifactorielle de 150 cas. Ann Chir 2006;131:104-11.
Potter JD, Slattery ML, Bostick RM, Gapstur SM. Colon cancer: a review of the epidemiology. Epidemiol Rev 1993;15:499-545.
Rougier et al. Cancer du colon : épidémiologie, anatomie pathologique, stades de Dukes, physiopathologie, diagnostic, évolution, principes du traitement et prévention. Rev Prat 1999;49:789-93.
Madbouly KM et al al. Long term prognostic value of mesorectal grading after neoadjuvant chemoradiotherapy for rectal cancer. Am J Surg 2014; doi: 10.1016/j.amjsurg.2013.10.023.
Jadad AR, Moore RA, Caroll D et al Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996 17:1-12.
Slim K, Nini E, Forestier D et al Methodological Index for Non-Randomized Studies (minors): development and validation of new instrument. ANZ J Surg 2003 73:712-6.
Clarke M. The QUORUM statement. Lancet 2000 Feb 26;355(9205):756-7.
Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009). http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
Mills KT et al al. Diabetes mellitus and colorectal cancer prognosis: a meta-analysis. Dis Colon Rectum 2013; 56:1304-19.
Zhou Y et al al. Outcome of laparoscopic colorectal surgery in obese and non obese patients: a meta-analysis. Surg Endosc 2012; 26:783-9.
Huang CS et al. Assessment of the value of carcinoembryonic antigen reduction ratio as a prognosis factor in rectal cancer. Am J Surg 2014 (article in press) http://dx.doi.org/10.1016/j.amjsurg.2013.08.054.
Ceelen W et al. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer: a systematic review and meta-analysis. Int J Cancer 2009;124: 2966-72.
Ceelen et al. Preoperative chemoradiation versus radiation alone for stage II and III resectable rectal cancer. Cochrane database of systematic reviews 2009, Issue 1. Art No:CD006041. DOI:10.1002/14651858.CD006041.pub2.
Fiorica F et al. Can chemotherapy concomitantantly delivered with radiotherapy improve survival of patients with resectable rectal cancer ?A meta-analysis of literature data. Cancer Treatment Reviews 2010;36:539-49.
Loupakis F et al. Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer: a meta-analysis of randomized clinical trials. Journal of Experimental and Clinical Cancer Research 2010;29:58-68.
Tulchinsky H et al. An interval >7 weeks between neoadjuvant therapy and surgery improves pathologic complete response and disease-free survival in patients with locally advanced rectal cancer. Ann Surg Oncol 2008;15:2661-7.
Yeo SG et al. Pathologic complete response of primary tumor following preoperative chemoradiotherapy for locally advanced rectal cancer: long term outcomes and prognostic significance of pathological nodal status. Ann Surg 2010;252: 998-1004.
Evans J et al. Timing of surgery following pre-operative therapy in rectal cancer: the need for a prospective randomized trial? Dis Colon Rectum 2011;54:1251-9.
Methy N et al. Surrogate end points for overall survival and local control in néoadjuvant rectal cancer trials: statistical evaluation based on the FFCD 9203 trial. Ann Oncol 2010;21:518-24.
Lefevre et al. A multicentric randomized controlled trial of the impact of lenghthening the interval between neoadjuvant radiochemotherapy and surgery on complete pathological response in rectal cancer (GRECCAR-6 trial): rationale and design. BMC Cancer 2013;417-25.
Zorcolo L et al. Complete pathologic response after combined modality treatment for rectal cancer and long-term survival: a meta-analysis. Ann SurgOncol 2012;19:2822-32.
Martin ST et al. Systematic review and meta-analysis of outcomes following pathological complete response to neoadjuvant chemoradiotherapy for rectal cancer. British Journal of Surgery 2012;99:918-28.
Lee Yc et al. Prognostic significance of partial tumor regression after preoperative chemoradiotherapy for rectal cancer: a meta-analysis. Dis Colon Rectum 2013;56:1093-101.
Coleman MP et al Cancer survival trends in England and Wales, 1971-1995: deprivation and NHS Region. The stationery office : London 1999.
McArdle CS et al. Male gender adversely affects survival following surgery for colorectal cancer. British Journal of Surgery, 2003;90:711-15.
Ward E et al. Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 2004;54:78-93.
Archampong D et al. Workload and surgeon's speciality for outcome after colorectal cancer surgery (Review). Cochrane Database of systematic reviews 2012, Issu 3. Art. No: CD005391. DOI: 10.1002/14651858.CD005391.pub3.
Archampong D et al al. Impact of surgeon volume on outcomes of rectal cancer surgery:
Jacobs M et al. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc 1991;1:144-50.
Guillou PJ et al. Short term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer: multicenter randomized controlled trial. Lancet 2005;365:1718-26.
Huang MJ et al. Meta-analysis of randomized controlled trials comparing laparoscopic with open surgery for rectal cancer on oncologic clearance and long-term oncologic outcomes. Zhonghua Wei Chang WaiKeZaZhi 2011;14:606-10.
Ohtani H et al. A meta-analysis of the short and long term results of randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for rectal cancer. J Gastrointest Surg 2011;15:1375-85.
Arezzo A et al. Laparoscopy for rectal cancer reduces short-term mortality and morbidity: result of a systematic review and meta-analysis. Surg Endosc 2013;27:1485-502.
Ma Y et al. A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol 2011;28:925-33.
Wu Y et al. TEM and conventional rectal surgery for T1 rectal cancer: a meta-analysis. Hepatogastroenterology 2011;58:364-8.
Hida JI et al. High ligation of the inferior mesenteric artery in rectal cancer surgery. Surg Today 2013;43:8-19.
Chen SC et al. Role of different ligation of the inferior mesenteric artery in sigmoid colon or rectal cancer surgery: a meta-analysis. Zhonghua Wei Chang WaiKeZaZhi 2010;9:674-7.
Liang YC et al. Total mesorectal excision versus conventional radical surgery for rectal cancer: a meta-analysis. Zhonghua Wei Chang WaiKeZaZhi 2007;10:43-8.
Wibe A, et al. A national strategic changing treatment policy for rectal cancer implementation of total mesorectal excision as routine treatment in Norway. A national audit. Dis Colon Rectum 2002;45:857-66.
Nagtegaal ID et al. Pathology review committee low rectal cancer: a call for a change of approach in abdominoperineal resection. J ClinOncol 2005;23:9257-64.
Schiessel R et al. Intersphincteric resection for low rectal tumors. Br J Surg 1994;81:1376-8.
Akagi Y et al. Intersphincteric resection for very low rectal cancer: a systematic review. Surg Today 2013;43:838-47.
Akagi Y et al. Oncologic outcomes of intersphincteric resection without preoperative chemoradiotherapy for very low rectal cancer. Surgical Oncology 2013;22:144-9.
Georgiou P et al. Extended lymphadenectomy versus conventional surgery for rectal cancer: a meta-analysis. Lancet Oncol 2009;10:1053-62.
Cheng H et al. Lateral lymph node dissection with radical surgery versus single radical surgery for rectal cancer: a meta-analysis. Asian Pacific J Cancer Prev 2011;12:2517-21.
Den Dulk M et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal surgery. Br J Surg 2009;96:1066-75.
Bhangu A et al. Mata-analysis of survival based on resection margin status following surgery for recurrent rectal cancer. Colorectal Dis 2012;14:1457-66.
Japanese Society for Cancer of the Colon and Rectum Guidelines (2010). Guidelines for the treatment of colorectal cancer (in japanese). Kanehara Shuppan, Tokyo.
Watanabe A et al. Influence of primary tumor resection on survival in asymptomatic patients with incurable stage IV colorectal cancer. Int J ClinOncol2014DOI 10.1007/s10147-014-0662-x.
Petersen SH et al. Postoperative adjuvant chemotherapy in rectal cancer operated for cure. Cochrane database of Systematic Reviews 2012, Issue 3. Art. No: CD004078. DOI: 10.1002/14651858.CD004078.pub2.
Des Guetz G et al. Does delaying adjuvant chemotherapy after curative surgery for colorectal cancer impair survival ? A meta-analysis. Eur J Canc 2010;46:1049-55.
Ratto R et al. Prognostic factors in colorectal cancer. Dis Colon Rectum 1998;41:1033-49.
Lasser Ph et al. Etude pronostique uni et multifactorielle de 400 adénocarcinomes rectaux réséqués. J.Chir 1993;130 :57-65.
Lee SD et al. Lymph node ratio is an independent prognostic factor in patients with rectal cancer treated with preoperative chemoradiotherapy and curative resection. EJSO 2012 ;38 :478-83.
Kasperk R, Willis S, Riesener KP, Schumpelick V. Evidence-based surgery of rectal carcinoma. Zentralbl Chir. 2001;126:295-301.
Xu L, Yao HW, Liu YH. To regulate the multimodality treatment of rectal cancer with evidence-based medicine. Zhonghua Wai Ke Za Zhi. 2009;47:965-7.
Ben Abid S, Hefaiedh R, Mzoughi Z, Miloudi N, Arfa Nafaa, Khalfallah MT. Quoi de neuf dans le cancer du rectum ? Tunis Med 2014;92(10):593-600.
