接受直肠癌术前放化疗患者的肿瘤反应及降期预测因素。

Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer.

作者信息

Das Prajnan, Skibber John M, Rodriguez-Bigas Miguel A, Feig Barry W, Chang George J, Wolff Robert A, Eng Cathy, Krishnan Sunil, Janjan Nora A, Crane Christopher H

机构信息

Department of Radiation Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

出版信息

Cancer. 2007 May 1;109(9):1750-5. doi: 10.1002/cncr.22625.

DOI:10.1002/cncr.22625

PMID:17387743

Abstract

BACKGROUND

The objective of this study was to identify predictive factors for pathologic complete response and tumor downstaging after preoperative chemoradiation for rectal cancer.

METHODS

Between 1989 and 2004, 562 patients with nonmetastatic rectal adenocarcinoma received preoperative chemoradiation and underwent mesorectal excision. The median radiation dose was 45 Gray (Gy) (range, 19.8-58.6 Gy), 77% of patients received concurrent infusional 5-fluorouracil, 20% of patients received concurrent capecitabine, and 3% of patients received other regimens.

RESULTS

Nineteen percent of patients achieved a pathologic complete response (CR), whereas 20% of patients had only microscopic residual disease at surgery, and 61% of patients had macroscopic residual disease at surgery. Downstaging of the tumor stage occurred in 57% of patients. The results from a univariate analysis indicated that tumor circumferential extent>60% (P=.033) and pretreatment carcinoembryonic antigen (CEA) level>2.5 ng/mL (P=.015) were associated significantly with lower pathologic CR rates. The univariate analysis also indicated that tumor circumferential extent>60% (P=.001), pretreatment CEA level>2.5 ng/mL (P=.006), and distance from the anal verge>5 cm (P=.035) were associated significantly with lower downstaging rates. The results from a multivariate logistic regression analysis indicated that greater circumferential extent of tumor (odds ratio [OR], 0.43; P=.033) independently predicted a lower pathologic CR rate. The multivariate logistic regression analysis also indicated that greater circumferential extent of tumor (OR, 0.49; P=.020) and greater distance from the anal verge (OR, 0.46; P=.010) independently predicted a lower downstaging rate.

CONCLUSIONS

Circumferential extent of tumor, CEA level, and distance from the anal verge predicted for the pathologic response to preoperative chemoradiation for patients with rectal cancer. Therefore, these factors may be used to predict outcomes for patients, to develop risk-adapted treatment strategies, and to target patients who participate in trials of newer therapies.

摘要

背景

本研究的目的是确定直肠癌术前放化疗后病理完全缓解和肿瘤降期的预测因素。

方法

1989年至2004年间，562例非转移性直肠腺癌患者接受了术前放化疗并进行了直肠系膜切除术。中位放疗剂量为45戈瑞（Gy）（范围19.8 - 58.6 Gy），77%的患者接受同步输注5-氟尿嘧啶，20%的患者接受同步卡培他滨，3%的患者接受其他方案。

结果

19%的患者达到病理完全缓解（CR），而20%的患者在手术时仅有微小残留病灶，61%的患者在手术时有肉眼可见的残留病灶。57%的患者出现肿瘤分期降期。单因素分析结果表明，肿瘤环周范围>60%（P = 0.033）和术前癌胚抗原（CEA）水平>2.5 ng/mL（P = 0.015）与较低的病理CR率显著相关。单因素分析还表明，肿瘤环周范围>60%（P = 0.001）、术前CEA水平>2.5 ng/mL（P = 0.006）以及距肛缘距离>5 cm（P = 0.035）与较低的降期率显著相关。多因素逻辑回归分析结果表明，更大的肿瘤环周范围（优势比[OR]，0.43；P = 0.033）独立预测较低的病理CR率。多因素逻辑回归分析还表明，更大的肿瘤环周范围（OR，0.49；P = 0.020）和距肛缘更大的距离（OR，0.46；P = 0.010）独立预测较低的降期率。