Garland Mikaela L, Vather Ryash, Bunkley Noah, Pearse Maria, Bissett Ian P
Department of Surgery, The University of Auckland, Auckland, New Zealand.
Int J Colorectal Dis. 2014 Mar;29(3):301-7. doi: 10.1007/s00384-013-1821-7. Epub 2014 Jan 14.
Pathologic complete response (pCR) to neoadjuvant treatment for rectal cancer has been associated with improved local control, reduced distant disease and a survival advantage when compared with non-complete responders. Approximately 10-25 % of patients undergoing neoadjuvant chemoradiotherapy for rectal cancer achieve pCR; however, predictors for its occurrence are inadequately defined. This study aimed to identify clinical and tumour factors that predict pCR in patients receiving neoadjuvant chemoradiotherapy for rectal cancer.
Consecutive rectal cancer patients diagnosed and treated in the Auckland region between 1 January 2002 and 1 February 2013 were retrospectively identified. Cases were stratified by the occurrence of pCR or non-pCR. Predictive capacity of several patient, tumour and treatment-related variables were then assessed by univariate and regression analyses.
Two hundred ninety-seven patients received neoadjuvant chemoradiotherapy, of whom 34 (11.4 %) achieved pCR. There were no significant differences in age, gender, ethnicity, BMI, pretreatment clinical T or N stage, tumour distance from the anal verge, tumour differentiation, chemoradiotherapy regimen and time interval to surgery between the pCR and non-pCR groups. Univariate analysis identified pretreatment serum CEA levels, a reduction in pre- to post-treatment serum CEA and smaller tumours as significant correlates of pCR. Logistic regression analysis found smaller tumour size and pretreatment clinical N stage as independent clinical predictors for achieving pCR.
Smaller tumour size and pretreatment clinical N stage were independent clinical predictors for achieving pCR. Prospective analysis is recommended for more rigorous risk factor assessment.
与未达到病理完全缓解的患者相比，直肠癌新辅助治疗后的病理完全缓解（pCR）与局部控制改善、远处疾病减少及生存优势相关。接受直肠癌新辅助放化疗的患者中约10%-25%可达到pCR；然而，其发生的预测因素尚未明确界定。本研究旨在确定接受直肠癌新辅助放化疗患者中预测pCR的临床和肿瘤因素。
回顾性纳入2002年1月1日至2013年2月1日在奥克兰地区诊断并接受治疗的连续性直肠癌患者。病例根据pCR或非pCR的发生情况进行分层。然后通过单因素分析和回归分析评估若干患者、肿瘤及治疗相关变量的预测能力。
297例患者接受了新辅助放化疗，其中34例（11.4%）达到pCR。pCR组和非pCR组在年龄、性别、种族、BMI、治疗前临床T或N分期、肿瘤距肛缘距离、肿瘤分化程度、放化疗方案及手术时间间隔方面无显著差异。单因素分析确定治疗前血清CEA水平、治疗前后血清CEA的降低以及较小的肿瘤为pCR的显著相关因素。逻辑回归分析发现较小的肿瘤大小和治疗前临床N分期是达到pCR的独立临床预测因素。
较小的肿瘤大小和治疗前临床N分期是达到pCR的独立临床预测因素。建议进行前瞻性分析以进行更严格的危险因素评估。
