放化疗后临床因素作为局部晚期直肠癌病理完全缓解的有价值指标
Clinical factors of post-chemoradiotherapy as valuable indicators for pathological complete response in locally advanced rectal cancer.
作者信息
Peng Jianhong, Lin Junzhong, Qiu Miaozhen, Wu Xiaojun, Lu Zhenhai, Chen Gong, Li Liren, Ding Peirong, Gao Yuanhong, Zeng Zhifan, Zhang Huizhong, Wan Desen, Pan Zhizhong
机构信息
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Colorectal Surgery.
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Department of Medical Oncology.
出版信息
Clinics (Sao Paulo). 2016 Aug;71(8):449-54. doi: 10.6061/clinics/2016(08)07.
OBJECTIVES
Pathological complete response has shown a better prognosis for patients with locally advanced rectal cancer after preoperative chemoradiotherapy. However, correlations between post-chemoradiotherapy clinical factors and pathologic complete response are not well confirmed. The aim of the current study was to identify post-chemoradiotherapy clinical factors that could serve as indicators of pathologic complete response in locally advanced rectal cancer.
METHODS
This study retrospectively analyzed 544 consecutive patients with locally advanced rectal cancer treated at Sun Yat-sen University Cancer Center from December 2003 to June 2014. All patients received preoperative chemoradiotherapy followed by surgery. Univariate and multivariate regression analyses were performed to identify post-chemoradiotherapy clinical factors that are significant indicators of pathologic complete response.
RESULTS
In this study, 126 of 544 patients (23.2%) achieved pathological complete response. In multivariate analyses, increased pathological complete response rate was significantly associated with the following factors: post-chemoradiotherapy clinical T stage 0-2 (odds ratio=2.098, 95% confidence interval=1.023-4.304, p=0.043), post-chemoradiotherapy clinical N stage 0 (odds ratio=2.011, 95% confidence interval=1.264-3.201, p=0.003), interval from completion of preoperative chemoradiotherapy to surgery of >7 weeks (odds ratio=1.795, 95% confidence interval=1.151-2.801, p=0.010) and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml (odds ratio=1.579, 95% confidence interval=1.026-2.432, p=0.038).
CONCLUSIONS
Post-chemoradiotherapy clinical T stage 0-2, post-chemoradiotherapy clinical N stage 0, interval from completion of chemoradiotherapy to surgery of >7 weeks and post-chemoradiotherapy carcinoembryonic antigen ≤2 ng/ml were independent clinical indicators for pathological complete response. These findings demonstrate that post-chemoradiotherapy clinical factors could be valuable for post-operative assessment of pathological complete response.
目的
病理完全缓解已显示出对局部晚期直肠癌患者术前放化疗后有更好的预后。然而，放化疗后临床因素与病理完全缓解之间的相关性尚未得到充分证实。本研究的目的是确定放化疗后可作为局部晚期直肠癌病理完全缓解指标的临床因素。
方法
本研究回顾性分析了2003年12月至2014年6月在中山大学肿瘤防治中心接受治疗的544例连续的局部晚期直肠癌患者。所有患者均接受术前放化疗，随后进行手术。进行单因素和多因素回归分析，以确定放化疗后作为病理完全缓解显著指标的临床因素。
结果
在本研究中，544例患者中有126例（23.2%）达到病理完全缓解。在多因素分析中，病理完全缓解率的增加与以下因素显著相关：放化疗后临床T分期0 - 2期（比值比=2.098，95%置信区间=1.023 - 4.304，p = 0.043）、放化疗后临床N分期0期（比值比=2.011，95%置信区间=1.264 - 3.201，p = 0.003）、从术前放化疗结束至手术的间隔时间>7周（比值比=1.795，95%置信区间=1.151 - 2.801，p = 0.010）以及放化疗后癌胚抗原≤2 ng/ml（比值比=1.579，95%置信区间=1.026 - 2.432，p = 0.038）。
结论
放化疗后临床T分期0 - 2期、放化疗后临床N分期0期、从放化疗结束至手术的间隔时间>7周以及放化疗后癌胚抗原≤2 ng/ml是病理完全缓解的独立临床指标。这些发现表明放化疗后临床因素对术后病理完全缓解的评估可能有价值。
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