Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Clin Colorectal Cancer. 2018 Mar;17(1):e21-e28. doi: 10.1016/j.clcc.2017.06.003. Epub 2017 Jun 23.
The utility of neoadjuvant radiotherapy (nRT) for the treatment of stage II and III rectal cancer is well-established. However, the optimal duration of nRT in this setting remains controversial. Using a population-based cohort of patients with stage II and III rectal cancer (RC) treated with curative intent, our aims were to (1) examine the patterns of nRT use and (2) explore the relationship between different nRT schedules and survival in the real-world setting.
This is a multi-center retrospective cohort study based on population-based data from 5 regional comprehensive cancer centers in British Columbia, Canada. We analyzed patients diagnosed with clinical stage II or III RC from 2006 to 2010 and treated with either short-course (SC) or long-course (LC) nRT prior to curative intent surgery. Logistic regression models were constructed to determine the factors associated with the course of nRT delivered to patients. Kaplan-Meier methods and Cox regression that accounted for known prognostic factors were used to evaluate the relationship between nRT schedule and overall (OS), disease-free (DFS), local recurrence-free (LRFS), and distant recurrence-free survival (DRFS).
We identified 427 patients: the median age was 65 years (range, 31 to 94 years), 67% were men, 87% had T3 or T4 tumors, and 74% had N1 or N2 disease. Among them, 241 (56%) received SC and 186 (44%) received LC. Adjusting for confounders, patients with N1 or N2 disease were more likely to undergo LC (odds ratio [OR], 5.08; 95% confidence interval [CI], 2.51-11.22; P < .0001 and OR, 8.35; 95% CI, 3.35-22.39; P < .0001, respectively), whereas older age patients were less likely to receive LC (OR, 0.95; 95% CI, 0.94-0.98; P < .0001). In Kaplan-Meier analysis, there were no significant differences observed in OS, DFS, LRFS, and DRFS between SC and LC. Likewise, multivariate analyses demonstrated that OS (hazard ratio [HR], 0.91; 95% CI, 0.61-1.37; P = .66), DFS (HR, 1.06; 95% CI, 0.68-1.64; P = .80), LRFS (HR, 0.79; 95% CI, 0.39-1.57; P = .50) and DRFS (HR, 0.99; 95% CI, 0.60-1.61; P = .95) were similar regardless of nRT schedules. Additional baseline clinical and tumor characteristics did not influence outcomes (all P > .05).
Appropriate preoperative selection of SC versus LC nRT for locally advanced RC based on patient and tumor characteristics was not associated with differences in survival outcomes in the real-world setting.
新辅助放疗（nRT）在治疗 II 期和 III 期直肠癌中的应用已经得到充分证实。然而，在这种情况下 nRT 的最佳持续时间仍然存在争议。本研究旨在利用以人群为基础的、接受根治性治疗的 II 期和 III 期直肠腺癌患者队列，（1）研究 nRT 使用的模式；（2）探讨不同 nRT 方案与真实世界中生存之间的关系。
这是一项基于加拿大不列颠哥伦比亚省 5 个区域综合癌症中心人群数据的多中心回顾性队列研究。我们分析了 2006 年至 2010 年间诊断为 II 期或 III 期临床直肠腺癌并接受短程（SC）或长程（LC）nRT 治疗的患者。使用逻辑回归模型确定影响患者接受 nRT 治疗方案的因素。采用 Kaplan-Meier 方法和 Cox 回归分析（考虑了已知的预后因素），评估 nRT 方案与总生存（OS）、无病生存（DFS）、局部无复发生存（LRFS）和远处无复发生存（DRFS）之间的关系。
我们共纳入 427 例患者：中位年龄为 65 岁（范围为 31-94 岁），67%为男性，87%的患者肿瘤分期为 T3 或 T4，74%的患者为 N1 或 N2 期。其中，241 例（56%）接受 SC，186 例（44%）接受 LC。调整混杂因素后，N1 或 N2 期的患者更倾向于接受 LC（比值比 [OR]，5.08；95%置信区间 [CI]，2.51-11.22；P<0.0001 和 OR，8.35；95%CI，3.35-22.39；P<0.0001），而老年患者更不可能接受 LC（OR，0.95；95%CI，0.94-0.98；P<0.0001）。Kaplan-Meier 分析显示，SC 和 LC 组之间 OS、DFS、LRFS 和 DRFS 无显著差异。同样，多变量分析表明 OS（风险比 [HR]，0.91；95%CI，0.61-1.37；P=0.66）、DFS（HR，1.06；95%CI，0.68-1.64；P=0.80）、LRFS（HR，0.79；95%CI，0.39-1.57；P=0.50）和 DRFS（HR，0.99；95%CI，0.60-1.61；P=0.95）相似，与 nRT 方案无关。其他基线临床和肿瘤特征对结果没有影响（均 P>0.05）。
根据患者和肿瘤特征，在真实世界环境中，对局部晚期 RC 进行适当的术前选择 SC 与 LC nRT 与生存结局无差异。
