Lee Jong Hoon, Hyun Jong Hee, Kim Dae Yong, Yoo Byong Chul, Park Ji Won, Kim Sun Young, Chang Hee Jin, Kim Byung Chang, Kim Tae Hyun, Oh Jae Hwan, Sohn Dae Kyung
Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea.
Ann Surg Oncol. 2015 Jan;22(1):209-15. doi: 10.1245/s10434-014-3962-5. Epub 2014 Nov 11.
To perform chemoradiotherapy (CRT) effectively, it is clinically beneficial to identify predictors of tumor response after CRT. This study examined the association between plasma fibrinogen level before preoperative CRT and tumor response in advanced rectal cancer.
This was a retrospective study of 947 patients who received preoperative CRT followed by curative surgery for primary rectal cancer. We analyzed clinical factors that could be associated with pathologic tumor response in terms of downstaging (ypStage 0-I), primary tumor regression (ypT0-1), and complete response (ypT0N0).
Downstaging was observed in 366 patients (38.6%), primary tumor regression in 187 patients (19.7%) and complete response in 138 patients (14.6%). Multivariate analysis found that pre-CRT carcinoembryonic antigen (CEA) level, fibrinogen level, hemoglobin level, clinical T and N classification, distance from anal verge, and histologic grade were significant predictive factors for downstaging; CEA level, fibrinogen level, and N classification predicted primary tumor regression; CEA level, and fibrinogen level were predictive for complete response.
This study demonstrated that fibrinogen level was a significant predictor of pathologic tumor response after preoperative CRT.
为有效实施放化疗（CRT），识别CRT后肿瘤反应的预测指标具有临床益处。本研究探讨了术前CRT前血浆纤维蛋白原水平与晚期直肠癌肿瘤反应之间的关联。
这是一项对947例接受术前CRT并随后接受原发性直肠癌根治性手术的患者的回顾性研究。我们分析了在降期（yp分期0-I）、原发性肿瘤退缩（ypT0-1）和完全缓解（ypT0N0）方面可能与病理肿瘤反应相关的临床因素。
366例患者（38.6%）出现降期，187例患者（19.7%）出现原发性肿瘤退缩，138例患者（14.6%）出现完全缓解。多因素分析发现，CRT前癌胚抗原（CEA）水平、纤维蛋白原水平、血红蛋白水平、临床T和N分类、距肛缘距离以及组织学分级是降期的显著预测因素；CEA水平、纤维蛋白原水平和N分类可预测原发性肿瘤退缩；CEA水平和纤维蛋白原水平可预测完全缓解。
本研究表明，纤维蛋白原水平是术前CRT后病理肿瘤反应的重要预测指标。
