Department of Surgery, Duke University, Durham, North Carolina, USA.
Department of Medicine, Duke University, Durham, North Carolina, USA.
Colorectal Dis. 2017 Dec;19(12):1058-1066. doi: 10.1111/codi.13754.
To examine the overall survival differences for the following neoadjuvant therapy modalities - no therapy, chemotherapy alone, radiation alone and chemoradiation - in a large cohort of patients with locally advanced rectal cancer.
Adults with clinical Stage II and III rectal adenocarcinoma were selected from the National Cancer Database and grouped by type of neoadjuvant therapy received: no therapy, chemotherapy only, radiotherapy only or chemoradiation. Multivariable regression methods were used to compare adjusted differences in perioperative outcomes and overall survival.
Among 32 978 patients included, 9714 (29.5%) received no neoadjuvant therapy, 890 (2.7%) chemotherapy only, 1170 (3.5%) radiotherapy only and 21 204 (64.3%) chemoradiation. Compared with no therapy, chemotherapy or radiotherapy alone were not associated with any adjusted differences in surgical margin positivity, permanent colostomy rate or overall survival (all P > 0.05). With adjustment, neoadjuvant chemoradiation vs no therapy was associated with a lower likelihood of surgical margin positivity (OR 0.74, P < 0.001), decreased rate of permanent colostomy (OR 0.77, P < 0.001) and overall survival [hazard ratio (HR) 0.79, P < 0.001]. When compared with chemotherapy or radiotherapy alone, chemoradiation remained associated with improved overall survival (vs chemotherapy alone HR 0.83, P = 0.04; vs radiotherapy alone HR 0.83, P < 0.019).
Neoadjuvant chemoradiation, not chemotherapy or radiotherapy alone, is important for sphincter preservation, R0 resection and survival for patients with locally advanced rectal cancer. Despite this finding, one-third of patients in the United States with locally advanced rectal cancer fail to receive stage-appropriate chemoradiation.
在一个大型局部晚期直肠癌患者队列中，检查以下新辅助治疗方式的总生存率差异-无治疗、单纯化疗、单纯放疗和放化疗。
从国家癌症数据库中选择临床 II 期和 III 期直肠腺癌成人患者，并按接受的新辅助治疗类型分组：无治疗、单纯化疗、单纯放疗或放化疗。采用多变量回归方法比较围手术期结局和总生存率的调整差异。
在纳入的 32978 例患者中，9714 例（29.5%）未接受新辅助治疗，890 例（2.7%）单纯化疗，1170 例（3.5%）单纯放疗，21204 例（64.3%）放化疗。与无治疗相比，单独化疗或放疗与手术切缘阳性、永久性结肠造口率或总生存率均无差异（均 P>0.05）。经调整后，与无治疗相比，新辅助放化疗与较低的手术切缘阳性率（OR 0.74，P<0.001）、永久性结肠造口率降低（OR 0.77，P<0.001）和总生存率（HR 0.79，P<0.001）相关。与单独化疗或放疗相比，放化疗仍与改善的总生存率相关（与单独化疗相比 HR 0.83，P=0.04；与单独放疗相比 HR 0.83，P<0.019）。
新辅助放化疗，而不是单纯化疗或放疗，对保留括约肌、R0 切除和局部晚期直肠癌患者的生存至关重要。尽管有此发现，但美国仍有三分之一的局部晚期直肠癌患者未接受分期适当的放化疗。
