Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Dresden, Germany.
Dis Colon Rectum. 2011 Apr;54(4):401-11. doi: 10.1007/DCR.0b013e3182070efb.
Neoadjuvant treatment in the multimodal therapy concept of rectal carcinoma has considerable effects on prognosis appraisal.
This study aimed to evaluate the tumor response specified as an improvement by at least one stage defined in terms of the International Union Against Cancer stages as a prognostic factor.
This investigation was designed as a prospective cohort study.
This study was performed at a community-based hospital with a specialized colorectal unit.
One hundred seventy-four patients with locally advanced rectal carcinoma, treated in the Dresden-Friedrichstadt hospital from 1997 to 2009, who received long-term preoperative chemoradiotherapy and underwent curative resection, were included in this study.
The main outcome measures were cause-specific and disease-free survival with respect to T and N category, International Union Against Cancer stage, venous and lymphatic invasions, grading, CEA level, complete pathologic response, tumor regression grading, International Union Against Cancer stage shift, T, N, and CEA shift, types of neoadjuvant therapy, adjuvant therapy, interval between completion of neoadjuvant chemoradiotherapy and surgery, and number of extracted lymph nodes in resected specimens. Univariate and multivariate analyses were performed.
Median follow-up was 45 months. One hundred twenty-one patients (69.5%) showed a response to the treatment, whereas 53 (30.5%) did not. Five-year cause-specific and disease-free survival for responders (n = 121) vs nonresponders (n = 53) were 92.6% and 73.7% vs 84.9% and 47.9%. In the univariate analysis, ypN category, venous and lymphatic invasion, tumor regression grading, International Union Against Cancer stage shift, and T and N shift were significantly predictive for cause-specific and disease-free survival. Furthermore, ypUICC stage, ypT category, grading, and complete pathologic response had an impact on disease-free survival. In the multivariate analysis, only the International Union Against Cancer stage shift kept its independent explanatory power for cause-specific P = .012, HR 3.10 (95% CI 1.28-7.51) and disease-free survival P < .001, HR 3.85 (95% CI 1.98-7.51).
The determination of International Union Against Cancer stage shift depends on the pretreatment staging modalities.
Our investigation demonstrates that the response of tumor to neoadjuvant therapy is an independent prognostic factor in patients with rectal carcinoma.
新辅助治疗在直肠癌多模式治疗概念中对预后评估有重要影响。
本研究旨在评估肿瘤反应，至少根据国际抗癌联合会（UICC）分期定义的一个阶段改善作为预后因素。
本研究设计为前瞻性队列研究。
本研究在一家具有专门结直肠单位的社区医院进行。
1997 年至 2009 年期间，174 例局部晚期直肠癌患者在德累斯顿-弗里德里希施塔特医院接受长期术前放化疗，并接受根治性切除术，纳入本研究。
主要观察指标为 T 和 N 分类、UICC 分期、静脉和淋巴浸润、分级、CEA 水平、完全病理缓解、肿瘤消退分级、UICC 分期转移、T、N 和 CEA 转移、新辅助治疗类型、辅助治疗、新辅助放化疗完成与手术之间的间隔以及切除标本中提取的淋巴结数量与无病生存和特定原因生存有关。进行了单因素和多因素分析。
中位随访时间为 45 个月。121 例（69.5%）患者对治疗有反应，53 例（30.5%）无反应。应答者（n=121）和无应答者（n=53）的 5 年特定原因生存和无病生存分别为 92.6%和 73.7%和 84.9%和 47.9%。单因素分析显示，ypN 分期、静脉和淋巴浸润、肿瘤消退分级、UICC 分期转移以及 T 和 N 转移对特定原因和无病生存有显著预测作用。此外，ypUICC 分期、ypT 分期、分级和完全病理缓解对无病生存有影响。多因素分析显示，只有 UICC 分期转移保持其对特定原因生存的独立解释能力（P=0.012，HR 3.10，95%CI 1.28-7.51）和无病生存（P<0.001，HR 3.85，95%CI 1.98-7.51）的意义。
UICC 分期转移的确定取决于术前分期方式。
我们的研究表明，肿瘤对新辅助治疗的反应是直肠癌患者的一个独立预后因素。
