Armstrong Dawn, Raissouni Soundouss, Price Hiller Julie, Mercer Jamison, Powell Erin, MacLean Anthony, Jiang Maria, Doll Corinne, Goodwin Rachel, Batuyong Eugene, Zhou Kevin, Monzon Jose G, Tang Patricia A, Heng Daniel Y, Cheung Winson Y, Vickers Michael M
Cross Cancer Institute, Edmonton, Alberta, Canada.
Tom Baker Cancer Centre, Calgary, Alberta, Canada.
Clin Colorectal Cancer. 2015 Dec;14(4):291-5. doi: 10.1016/j.clcc.2015.06.001. Epub 2015 Jun 18.
Pathologic complete response (pCR) to neoadjuvant chemoradiation (CRT) for rectal cancer is associated with better long-term outcomes, and is used as an early indicator of response to novel agents. To assess the rate and predictors of pCR, we performed a retrospective multicenter study involving 5 Canadian cancer centers.
Cancer registries identified consecutive patients with locally advanced rectal adenocarcinoma from the Tom Baker Cancer Centre, Cross Cancer Institute, British Columbia Cancer Agency, Ottawa Hospital Cancer Centre, and the Dr H. Bliss Murphy Cancer Centre who received fluoropyrimidine-based CRT and had curative intent surgery from 2005 to 2012. Patient, tumor, and therapy characteristics were correlated with response.
Of the 891 patients included, 885 patients had pCR data available. Of the included patients, 161 (18.2%) had a pCR to CRT, and 724 (81.8%) did not. Patients with a pCR had a lower pretreatment carcinoembryonic antigen (CEA) level, and higher hemoglobin level in univariate analysis. In multivariable analysis, statin use at baseline (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.02-2.92; P = .04), lower pretreatment CEA level (OR, 1.03; 95% CI, 1.01-1.06; P = .03), and distance closer to anal verge (OR, 1.07; 95% CI, 1.01-1.15; P = .04) were significant predictors of pCR. The 3-year disease-free survival was 86% in those with a pCR versus 62.5% in those without a pCR (P < .0001) and pCR was associated with improved overall survival (hazard ratio, 0.29; 95% CI, 0.17-0.51; P < .0001).
Lower pretreatment CEA level, proximity to anal verge, and statin use are predictors of pCR in our large retrospective cohort. Clinical trials to investigate statins combined with neoadjuvant CRT might be warranted.
直肠癌新辅助放化疗（CRT）后的病理完全缓解（pCR）与更好的长期预后相关，并被用作对新型药物反应的早期指标。为了评估pCR的发生率及预测因素，我们开展了一项涉及加拿大5家癌症中心的回顾性多中心研究。
癌症登记处识别出了来自汤姆·贝克癌症中心、十字癌症研究所、不列颠哥伦比亚癌症机构、渥太华医院癌症中心以及H. 布利斯·墨菲癌症中心的连续的局部晚期直肠腺癌患者，这些患者在2005年至2012年间接受了以氟嘧啶为基础的CRT并进行了根治性手术。将患者、肿瘤及治疗特征与反应情况进行关联分析。
纳入的891例患者中，885例患者有pCR数据。在纳入患者中，161例（18.2%）对CRT达到pCR，724例（81.8%）未达到。单因素分析显示，达到pCR的患者治疗前癌胚抗原（CEA）水平较低，血红蛋白水平较高。多因素分析中，基线使用他汀类药物（比值比[OR]，1.7；95%置信区间[CI]，1.02 - 2.92；P = .04）、治疗前CEA水平较低（OR，1.03；95% CI，1.01 - 1.06；P = .03）以及距肛缘距离更近（OR，1.07；95% CI，1.01 - 1.15；P = .04）是pCR的显著预测因素。达到pCR的患者3年无病生存率为86%，未达到pCR的患者为62.5%（P < .0001），且pCR与总生存改善相关（风险比，0.29；95% CI，0.17 - 0.51；P < .0001）。
在我们这个大型回顾性队列中，治疗前CEA水平较低、距肛缘较近以及使用他汀类药物是pCR的预测因素。或许有必要开展研究他汀类药物联合新辅助CRT的临床试验。
