Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Res. 2019 Nov;243:447-452. doi: 10.1016/j.jss.2019.06.089. Epub 2019 Jul 31.
Current treatment for locally advanced rectal cancer includes neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy. With neoadjuvant chemotherapy (NC), both chemoradiation and chemotherapy are given in the neoadjuvant setting. This study aims to assess patterns of NC utilization and differences in treatment response compared with standard treatment at our institution.
We performed a retrospective review of patients treated for stage II-III rectal cancer at our institution between 2008 and 2018, examining patient demographics, tumor characteristics, and treatment modality. The primary outcome of interest was complete response (CR) to treatment, including both pathologic and clinical CR.
Of 184 patients, 134 (72.8%) received standard therapy, and 50 (27.2%) received NC. In the standard treatment group, 70.1% were node positive, and 9.0% had T4-disease, compared with 92.0% and 26.0% in the NC group, respectively (both P < 0.01). NC utilization increased over time, with 3.4% of patients receiving NC between 2008 and 2012, compared with 48.5% in 2013-2018 (P < 0.01). CR was achieved in 19.4% versus 34.0% (P < 0.01) of patients in standard versus NC groups. With multivariate analysis, NC (odds ratio = 3.02 [95% confidence interval 1.37-6.67], P = 0.01) was associated with increased likelihood of achieving CR, whereas higher T-stage was associated with decreased likelihood of CR (for cT4, odds ratio = 0.06 [95% confidence interval 0.01-0.56], P = 0.01).
Use of NC was increasingly used at our institution from 2008 to 2018. Patients who received NC achieved higher rates of CR compared with those undergoing standard therapy, despite having more advanced disease. These data support trends from other institutions and provides rationale for further study regarding use of NC for locally advanced rectal cancer.
目前，局部晚期直肠癌的治疗包括新辅助放化疗后手术和辅助化疗。新辅助化疗（NC）中，放化疗和化疗都在新辅助治疗中进行。本研究旨在评估我院新辅助化疗的应用模式，并与标准治疗相比，评估其在治疗反应方面的差异。
我们对我院 2008 年至 2018 年间治疗的 II-III 期直肠癌患者进行了回顾性研究，分析了患者的人口统计学、肿瘤特征和治疗方式。主要研究终点是治疗的完全缓解（CR），包括病理和临床 CR。
在 184 例患者中，134 例（72.8%）接受了标准治疗，50 例（27.2%）接受了 NC。在标准治疗组中，70.1%的患者有淋巴结阳性，9.0%的患者有 T4 期疾病，而 NC 组分别为 92.0%和 26.0%（均 P<0.01）。随着时间的推移，NC 的应用逐渐增加，2008 年至 2012 年期间有 3.4%的患者接受 NC，而 2013 年至 2018 年期间有 48.5%的患者接受 NC（均 P<0.01）。标准治疗组和 NC 组的 CR 率分别为 19.4%和 34.0%（P<0.01）。多因素分析显示，NC（比值比=3.02[95%置信区间 1.37-6.67]，P=0.01）与 CR 可能性增加相关，而较高的 T 分期与 CR 可能性降低相关（对于 cT4，比值比=0.06[95%置信区间 0.01-0.56]，P=0.01）。
我院从 2008 年至 2018 年期间，NC 的应用逐渐增加。与接受标准治疗的患者相比，接受 NC 的患者 CR 率更高，尽管他们的疾病更为晚期。这些数据支持来自其他机构的趋势，并为进一步研究 NC 在局部晚期直肠癌中的应用提供了依据。
