Bohlok Ali, Hendlisz Alain, Bouazza Fikri, Galdon Maria Gomez, Van de Stadt Jean, Moretti Luigi, El Nakadi Issam, Liberale Gabriel
Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Department of Gastro-enterology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Int J Colorectal Dis. 2018 Oct;33(10):1383-1391. doi: 10.1007/s00384-018-3115-6. Epub 2018 Jul 8.
Recommended treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NACRT) followed by surgery and total mesorectal excision (TME). The role of adjuvant chemotherapy (ACT) in this regimen is still debated. Assessment of Dworak's tumor regression grade (TRG) after NACRT could potentially select patients who might benefit from ACT.
Data for patients who underwent NACRT and TME for LARC between 2007 and 2014 were retrieved from the Bordet Institute database. Overall survival (OS) and disease-free survival (DFS) were calculated for the whole population, according to whether or not they received ACT, and according to TRG.
We included 74 patients (38 males) with a median age of 62.7 years (33-84 years). AJCC stage cIIIb disease was the most frequent (73%). Pathologic complete response (pCR) was achieved in 13 patients (17.6%). ACT was administered to 42 patients (56.8%). Five-year OS and DFS of patients who received ACT or not were 92 and 84.5% (p = ns), and 79.9 and 84.8% (p = ns), respectively. OS was related to TRG (cut-off value of 3) (p = 0.001). ACT administration was not correlated with improved outcomes in any TRG groups.
TRG is a prognostic factor for both OS and DFS but does not appear to have a significant benefit for the selection of patients with LARC treated with NACRT who might benefit from the administration of ACT. Prospective randomized trials with larger populations are needed to identify factors that predict which patients may benefit from the administration of ACT.
局部晚期直肠癌（LARC）的推荐治疗方法是新辅助放化疗（NACRT），随后进行手术和全直肠系膜切除术（TME）。辅助化疗（ACT）在该治疗方案中的作用仍存在争议。NACRT后评估德沃拉克肿瘤退缩分级（TRG）可能有助于筛选出可能从ACT中获益的患者。
从博尔德研究所数据库中检索2007年至2014年间接受NACRT和TME治疗的LARC患者的数据。根据患者是否接受ACT以及TRG情况，计算整个人群的总生存期（OS）和无病生存期（DFS）。
我们纳入了74例患者（38例男性），中位年龄为62.7岁（33 - 84岁）。美国癌症联合委员会（AJCC）cIIIb期疾病最为常见（73%）。13例患者（17.6%）达到病理完全缓解（pCR）。42例患者（56.8%）接受了ACT。接受ACT或未接受ACT的患者5年OS和DFS分别为92%和84.5%（p = 无显著性差异），以及79.9%和84.8%（p = 无显著性差异）。OS与TRG相关（临界值为3）（p = 0.001）。在任何TRG组中，ACT的使用与改善预后均无相关性。
TRG是OS和DFS的预后因素，但对于筛选接受NACRT治疗且可能从ACT中获益的LARC患者而言，似乎并无显著益处。需要开展更大规模人群的前瞻性随机试验，以确定哪些因素可预测哪些患者可能从ACT中获益。
