Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Int J Colorectal Dis. 2012 May;27(5):613-21. doi: 10.1007/s00384-011-1348-8. Epub 2011 Nov 15.
Pathologic complete response has been proven to have oncological benefits for locally advanced rectal cancer treated with chemoradiation therapy. The aims of this study are to analyze and determine the factors to predict pathologic complete response for patients treated with preoperative neoadjuvant therapy.
Patients with biopsy-proven, locally advanced rectal cancer were treated neoadjuvantly followed by radical surgical resection. Tumors were re-assessed after completing chemoradiation, including pelvic magnetic resonance images, colonoscopic examination, and re-biopsy. The results of examination were compared with the final pathologic status.
A retrospective chart review of 166 patients was conducted. Twenty-five patients (15.1%) had pathologic complete response after chemoradiation. The 5-year overall survival rates were better in the complete response group than the residual tumor group (91.1% vs. 70.8%; P = 0.047), and there were also significant differences in the 5-year disease-free survival rates between these two groups (91.1% vs. 70.2%; P = 0.027). The prediction rates for pathologic complete response by re-biopsy, magnetic resonance images, and colonoscopy were 21.4%, 33.3%, and 53.8%, respectively. In addition, when we further combine the results of colonoscopic findings and re-biopsy, the prediction rate for pathologic complete response reached 77.8% (P = 0.009).
Combining the results of the re-biopsy and post-treatment colonoscopic findings, we can achieve a good prediction rate for pathologic complete response. Post-treatment magnetic resonance images are not useful tools in predicting tumor clearance following chemoradiation.
病理完全缓解已被证明对接受放化疗的局部晚期直肠癌具有肿瘤学益处。本研究旨在分析并确定预测接受术前新辅助治疗的患者病理完全缓解的因素。
经活检证实患有局部晚期直肠癌的患者接受新辅助治疗，然后进行根治性手术切除。在完成放化疗后，重新评估肿瘤，包括盆腔磁共振成像、结肠镜检查和再次活检。将检查结果与最终病理状态进行比较。
对 166 例患者进行了回顾性图表审查。25 例患者（15.1%）在放化疗后出现病理完全缓解。完全缓解组的 5 年总生存率优于残留肿瘤组（91.1% vs. 70.8%；P = 0.047），两组 5 年无病生存率也有显著差异（91.1% vs. 70.2%；P = 0.027）。再次活检、磁共振成像和结肠镜检查预测病理完全缓解的准确率分别为 21.4%、33.3%和 53.8%。此外，当我们进一步结合结肠镜检查结果和再次活检时，病理完全缓解的预测率达到 77.8%（P = 0.009）。
结合再次活检和治疗后结肠镜检查结果，我们可以实现对病理完全缓解的良好预测率。治疗后磁共振成像不是预测放化疗后肿瘤清除的有用工具。
