Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
Colorectal Dis. 2011 Dec;13(12):1353-60. doi: 10.1111/j.1463-1318.2011.02570.x.
The study aimed to identify the factors predictive for extreme unresponsiveness to neoadjuvant therapy for rectal cancer.
Ninety-six patients with rectal cancer received neoadjuvant therapy (41 were treated with radiotherapy and 55 with chemoradiotherapy) before surgery. Tumour response, downstaging, pathological complete response (pCR) and disease-free survival were evaluated.
Tumour response, downstaging and pCR occurred in 70 (72.9%), 47 (49.0%) and 14 (14.6%) patients, respectively. Univariate analyses showed that a large tumour size, T4 stage, elevated serum tumour markers, poor differentiation, radiotherapy alone and mucinous tumour were indicators of poor tumour response and/or downstaging. On multivariate analysis, chemoradiotherapy was found to be predictive for tumour response and downstaging, whereas mucinous type and T4 stage negatively affected tumour response. No variable was found to be associated with pCR, but poor differentiation and T4 stage together predicted extreme unresponsiveness with a high specificity and a high positive predictive value. Very poor disease-free survival was also observed in patients simultaneously carrying these phenotypes.
Neoadjuvant chemoradiotherapy is superior to radiotherapy alone in producing a response of rectal cancer. Unresponsiveness was most likely to occur in patients with poor differentiation and T4 disease.
本研究旨在确定预测直肠癌新辅助治疗极度无反应的因素。
96 例直肠癌患者在手术前接受新辅助治疗（41 例接受放疗，55 例接受放化疗）。评估肿瘤反应、降期、病理完全缓解（pCR）和无病生存情况。
70 例（72.9%）、47 例（49.0%）和 14 例（14.6%）患者分别发生肿瘤反应、降期和 pCR。单因素分析显示，肿瘤较大、T4 期、血清肿瘤标志物升高、分化差、单纯放疗和黏液瘤是肿瘤反应和/或降期不良的指标。多因素分析发现，放化疗是肿瘤反应和降期的预测因素，而黏液型和 T4 期则对肿瘤反应产生负面影响。没有变量与 pCR 相关，但低分化和 T4 期共同预测高度无反应，具有较高的特异性和阳性预测值。同时携带这些表型的患者无病生存也很差。
新辅助放化疗在产生直肠癌反应方面优于单纯放疗。无反应最有可能发生在分化差和 T4 期的患者中。
