van der Sluis Frederik J, van Westreenen Henderik L, van Etten Boudewijn, van Leeuwen Barbara L, de Bock Geertruida H
Department of Surgery, Isala Clinics, Dr. Van Heesweg 2, 8025, AB, Zwolle, The Netherlands.
Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Int J Colorectal Dis. 2018 Feb;33(2):149-157. doi: 10.1007/s00384-017-2939-9. Epub 2017 Dec 15.
In selected patients, a wait-and-see strategy after chemoradiotherapy for rectal cancer might be feasible provided that the probability of pathologic complete response (pCR) is high. This study aimed to identify clinical parameters associated with pCR. Furthermore, we attempted to identify subgroups with increased probability of pCR that might aid in clinical decision making.
A total of 6444 patients that underwent surgical resection of a single primary carcinoma of the rectum after neoadjuvant chemoradiotherapy (nCRT) between January 2009 and December 2016 in the Netherlands were included in the study. Data on the outcome variable, pCR, and potential covariates were retrieved from a nationwide database. The variables included in the analysis were selected based on previous studies and were analyzed using univariate and multivariate logistic regression analyses.
pCR was observed in 1010 patients (15.7%). Pretreatment clinical tumor stage and signs of obstruction were independently associated with pCR. Nodal stage and presence of metastatic disease decreased chances of pCR significantly. The best response rate was observed in patients diagnosed with a non-obstructive, well-/moderately differentiated adenocarcinoma of the lower rectum with no clinical apparent nodal or distant metastatic disease (pCR ratio 18.8%). The percentage of patients demonstrating pCR decreased in case of symptoms of pretreatment obstruction or poorly differentiated tumors (pCR ratio of 11.8 and 6.7%, respectively).
This nationwide study confirms several of the previously reported clinical predictors of pCR.
在部分患者中，若病理完全缓解（pCR）概率较高，直肠癌放化疗后采取观察等待策略可能是可行的。本研究旨在确定与pCR相关的临床参数。此外，我们试图确定pCR概率增加的亚组，这可能有助于临床决策。
纳入2009年1月至2016年12月在荷兰接受新辅助放化疗（nCRT）后行直肠原发性癌手术切除的6444例患者。从全国性数据库中检索关于结局变量pCR和潜在协变量的数据。分析中纳入的变量基于先前研究进行选择，并使用单因素和多因素逻辑回归分析进行分析。
1010例患者（15.7%）观察到pCR。治疗前临床肿瘤分期和梗阻体征与pCR独立相关。淋巴结分期和转移疾病的存在显著降低了pCR的几率。在诊断为低位直肠非梗阻性、高/中分化腺癌且无临床明显淋巴结或远处转移疾病的患者中观察到最佳缓解率（pCR率18.8%）。若存在治疗前梗阻症状或低分化肿瘤，出现pCR的患者百分比降低（pCR率分别为11.8%和6.7%）。
这项全国性研究证实了先前报道的几个pCR临床预测因素。
