Institute for Clinical Outcomes, Research and Education and Department of Colorectal Surgery, St Vincent's University Hospital, Dublin, Ireland.
Br J Surg. 2012 Jul;99(7):918-28. doi: 10.1002/bjs.8702. Epub 2012 Feb 23.
Following neoadjuvant chemoradiotherapy (CRT) and interval proctectomy, 15-20 per cent of patients are found to have a pathological complete response (pCR) to combined multimodal therapy, but controversy persists about whether this yields a survival benefit. This systematic review evaluated current evidence regarding long-term oncological outcomes in patients found to have a pCR to neoadjuvant CRT.
Three major databases (PubMed, MEDLINE and the Cochrane Library) were searched. The systematic review included all original articles reporting long-term outcomes in patients with rectal cancer who had a pCR to neoadjuvant CRT, published in English, from January 1950 to March 2011.
A total of 724 studies were identified for screening. After applying inclusion and exclusion criteria, 16 studies involving 3363 patients (1263 with pCR and 2100 without) were included (mean age 60 years, 65·0 per cent men). Some 73·4 per cent had a sphincter-saving procedure. Mean follow-up was 55·5 (range 40-87) months. For patients with a pCR, the weighted mean local recurrence rate was 0·7 (range 0-2·6) per cent. Distant failure was observed in 8·7 per cent. Five-year overall and disease-free survival rates were 90·2 and 87·0 per cent respectively. Compared with non-responders, a pCR was associated with fewer local recurrences (odds ratio (OR) 0·25; P = 0·002) and less frequent distant failure (OR 0·23; P < 0·001), with a greater likelihood of being alive (OR 3·28; P = 0·001) and disease-free (OR 4·33, P < 0·001) at 5 years.
A pCR following neoadjuvant CRT is associated with excellent long-term survival, with low rates of local recurrence and distant failure.
新辅助放化疗（CRT）和间隔直肠切除术后，15-20%的患者对联合多模式治疗有病理完全缓解（pCR），但关于这是否带来生存获益仍存在争议。本系统评价评估了新辅助 CRT 后 pCR 患者的长期肿瘤学结局的现有证据。
检索了三个主要数据库（PubMed、MEDLINE 和 Cochrane 图书馆）。系统评价纳入了所有报道新辅助 CRT 后 pCR 患者长期结局的原始文章，发表语言为英文，时间跨度为 1950 年 1 月至 2011 年 3 月。
共筛选出 724 篇研究，经过纳入和排除标准，纳入 16 项研究共 3363 例患者（pCR 组 1263 例，无 pCR 组 2100 例）（平均年龄 60 岁，男性占 65.0%）。约 73.4%的患者接受了保肛手术。平均随访时间为 55.5（40-87）个月。pCR 患者的局部复发率加权平均值为 0.7%（0-2.6%）。远处转移率为 8.7%。5 年总生存率和无病生存率分别为 90.2%和 87.0%。与无应答者相比，pCR 与较少的局部复发（比值比（OR）0.25；P = 0.002）和远处转移（OR 0.23；P < 0.001）相关，并且在 5 年时更有可能存活（OR 3.28；P = 0.001）和无病（OR 4.33，P < 0.001）。
新辅助 CRT 后 pCR 与良好的长期生存相关，局部复发和远处转移率低。
