Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):e193-9. doi: 10.1016/j.ijrobp.2011.03.022. Epub 2011 May 24.
To investigate the prognostic significance of tumor volume reduction rate (TVRR) after preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC).
In total, 430 primary LARC (cT3-4) patients who were treated with preoperative CRT and curative radical surgery between May 2002 and March 2008 were analyzed retrospectively. Pre- and post-CRT tumor volumes were measured using three-dimensional region-of-interest MR volumetry. Tumor volume reduction rate was determined using the equation TVRR (%) = (pre-CRT tumor volume--post-CRT tumor volume) × 100/pre-CRT tumor volume. The median follow-up period was 64 months (range, 27-99 months) for survivors. Endpoints were disease-free survival (DFS) and overall survival (OS).
The median TVRR was 70.2% (mean, 64.7% ± 22.6%; range, 0-100%). Downstaging (ypT0-2N0M0) occurred in 183 patients (42.6%). The 5-year DFS and OS rates were 77.7% and 86.3%, respectively. In the analysis that included pre-CRT and post-CRT tumor volumes and TVRR as continuous variables, only TVRR was an independent prognostic factor. Tumor volume reduction rate was categorized according to a cutoff value of 45% and included with clinicopathologic factors in the multivariate analysis; ypN status, circumferential resection margin, and TVRR were significant prognostic factors for both DFS and OS.
Tumor volume reduction rate was a significant prognostic factor in LARC patients receiving preoperative CRT. Tumor volume reduction rate data may be useful for tailoring surgery and postoperative adjuvant therapy after preoperative CRT.
研究局部晚期直肠癌（LARC）患者术前放化疗（CRT）后肿瘤体积减少率（TVRR）的预后意义。
回顾性分析了 2002 年 5 月至 2008 年 3 月期间接受术前 CRT 和根治性手术治疗的 430 例原发性 LARC（cT3-4）患者。使用三维感兴趣区 MR 体绘制技术测量术前和 CRT 后的肿瘤体积。肿瘤体积减少率通过公式 TVRR（%）=（术前肿瘤体积-术后肿瘤体积）×100/术前肿瘤体积来确定。生存者的中位随访时间为 64 个月（范围 27-99 个月）。终点是无病生存率（DFS）和总生存率（OS）。
中位 TVRR 为 70.2%（平均值 64.7%±22.6%；范围 0-100%）。183 例患者（42.6%）降期为 ypT0-2N0M0。5 年 DFS 和 OS 率分别为 77.7%和 86.3%。在包括术前和术后肿瘤体积以及 TVRR 作为连续变量的分析中，只有 TVRR 是独立的预后因素。根据 45%的截断值将肿瘤体积减少率进行分类，并将其与多变量分析中的临床病理因素相结合；ypN 状态、环周切缘和 TVRR 是 DFS 和 OS 的显著预后因素。
肿瘤体积减少率是接受术前 CRT 的 LARC 患者的一个重要预后因素。肿瘤体积减少率数据可能有助于为术前 CRT 后的手术和术后辅助治疗提供指导。
