Department of Pathology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
Netherlands Comprehensive Cancer Organization/Netherlands Cancer Registry, P.O. Box 19079, 3501 DB, Utrecht, The Netherlands.
Virchows Arch. 2019 Dec;475(6):745-755. doi: 10.1007/s00428-019-02638-1. Epub 2019 Aug 28.
Preoperative chemoradiation therapy (CRT) may induce downstaging in rectal cancer (RC). Short-course radiation therapy (SC-RT) with immediate surgery does not cause substantial downstaging. However, the TNM classification adds the "y" prefix in both groups to indicate possible treatment effects. We aim to compare stage-specific survival in these patients. RC patients treated with surgery only, preoperative SC-RT followed by surgery within 10 days, or preoperative CRT, and diagnosed between 2008 and 2014 were included in this population-based study. Clinicopathological and outcome characteristics were analyzed. The study included 11,925 patients. Large discrepancies existed between clinical and pathological stages after surgery only. Surgery-only patients were older with more comorbidities compared with SC-RT and CRT and had worse 5-year survival (64%, 76%, and 74%, respectively; p < 0.001). Five-year survival for stage I was similar after CRT and SC-RT (85% vs. 85%; p = 0.167) and comparable between CRT-treated patients with stage I and those reaching a pathological complete response (pCR; 85% vs. 89%; p = 0.113). CRT was independently associated with worse overall survival compared with SC-RT for stage II (HR 1.57 [95%CI 1.27-1.95]; p < 0.001) and stage III (HR 1.43 [95%CI 1.23-1.70]; p < 0.001). Stage I disease after CRT has an excellent prognosis, comparable with pCR and with same-stage SC-RT-treated patients without regression. Stage II or III after CRT has worse prognosis than after SC-RT with immediate surgery. TNM should take the impact of preoperative therapy type on stage-specific survival into account. In addition, clinical stage was a poor predictor of pathological stage.
术前放化疗（CRT）可能使直肠癌（RC）降期。短程放疗（SC-RT）加立即手术不会引起明显降期。然而，TNM 分类在两组中都添加了“y”前缀，表示可能的治疗效果。我们旨在比较这些患者的特定于阶段的生存情况。本基于人群的研究纳入了仅接受手术、术前 SC-RT 后 10 天内手术或术前 CRT 治疗且于 2008 年至 2014 年间诊断为 RC 的患者。分析了临床病理和结局特征。该研究纳入了 11925 例患者。仅接受手术的患者术后临床和病理分期存在较大差异。仅接受手术的患者比 SC-RT 和 CRT 患者年龄更大，合并症更多，5 年生存率也更差（分别为 64%、76%和 74%；p<0.001）。CRT 和 SC-RT 治疗后 I 期患者 5 年生存率相似（85%比 85%；p=0.167），达到病理完全缓解（pCR）的 CRT 治疗患者与 I 期患者的 5 年生存率相似（85%比 89%；p=0.113）。与 SC-RT 相比，CRT 与 II 期（HR 1.57[95%CI 1.27-1.95]；p<0.001）和 III 期（HR 1.43[95%CI 1.23-1.70]；p<0.001）患者的总体生存相关更差。CRT 后 I 期疾病预后极好，与 pCR 相似，与无消退的同分期 SC-RT 治疗患者相似。CRT 后 II 期或 III 期疾病的预后比 SC-RT 加立即手术差。TNM 应考虑术前治疗类型对特定于阶段的生存的影响。此外，临床分期是病理分期的不良预测因子。
