Song Ji Hyeong, Park Yo-Han, Seo Sang Hyuk, Lee Anbok, Kim Kwang Hee, An Min Sung, Bae Ki Beom, Hong Kwan Hee, Hwang Jin Won, Kim Ji Hyun, Jung Hyun Seok, Ahn Ki Jung
Department of Surgery, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
Ann Coloproctol. 2017 Dec;33(6):219-226. doi: 10.3393/ac.2017.33.6.219. Epub 2017 Dec 31.
This study was conducted to discover the clinical factors that can predict pathologically complete remission (pCR) after neoadjuvant chemoradiotherapy (CRT), so that those factors may help in deciding on a treatment program for patients with locally advanced rectal cancer.
A total of 137 patients with locally advanced rectal cancer were retrospectively enrolled in this study, and data were collected retrospectively. The patients had undergone a total mesorectal excision after neoadjuvant CRT. Histologic response was categorized as pCR vs. non-pCR. The tumor area was defined as (tumor length) × (maximum tumor depth). The difference in tumor area was defined as pre-CRT tumor area - post-CRT tumor area. Univariate and multivariate logistic regression analyses were conducted to find the factors affecting pCR. A P-value < 0.05 was considered significant.
Twenty-three patients (16.8%) achieved pCR. On the univariate analysis, endoscopic tumor circumferential rate <50%, low pre-CRT T & N stage, low post-CRT T & N stage, small pretreatment tumor area, and large difference in tumor area before and after neoadjuvant CRT were predictive factors of pCR. A multivariate analysis found that only the difference in tumor area before and after neoadjuvant CRT was an independent predictor of pCR (P < 0.001).
The difference in tumor area, as determined using radiologic tools, before and after neoadjuvant CRT may be important predictor of pCR. This clinical factor may help surgeons to determine which patients who received neoadjuvant CRT for locally advanced rectal cancer should undergo surgery.
本研究旨在发现可预测新辅助放化疗（CRT）后病理完全缓解（pCR）的临床因素，以便这些因素有助于为局部晚期直肠癌患者确定治疗方案。
本研究回顾性纳入了137例局部晚期直肠癌患者，并回顾性收集数据。患者在新辅助CRT后接受了全直肠系膜切除术。组织学反应分为pCR和非pCR。肿瘤面积定义为（肿瘤长度）×（最大肿瘤深度）。肿瘤面积差异定义为CRT前肿瘤面积 - CRT后肿瘤面积。进行单因素和多因素逻辑回归分析以找出影响pCR的因素。P值<0.05被认为具有统计学意义。
23例患者（16.8%）达到pCR。单因素分析显示，内镜下肿瘤环周率<50%、CRT前T和N分期低、CRT后T和N分期低、治疗前肿瘤面积小以及新辅助CRT前后肿瘤面积差异大是pCR的预测因素。多因素分析发现，只有新辅助CRT前后肿瘤面积差异是pCR的独立预测因素（P < 0.001）。
新辅助CRT前后使用影像学工具确定的肿瘤面积差异可能是pCR的重要预测因素。这一临床因素可能有助于外科医生确定哪些接受新辅助CRT治疗的局部晚期直肠癌患者应接受手术。
