Huang Chun-Ming, Huang Ching-Wen, Ma Cheng-Jen, Yeh Yung-Sung, Su Wei-Chih, Chang Tsung-Kun, Tsai Hsiang-Lin, Juo Suh-Hang, Huang Ming-Yii, Wang Jaw-Yuan
Department of Radiation Oncology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
J Oncol. 2020 Jan 28;2020:9437684. doi: 10.1155/2020/9437684. eCollection 2020.
We aimed to identify predictors of a pathological complete response (pCR) in patients with locally advanced rectal cancer (LARC) following a multimodality therapy. We retrospectively reviewed 236 patients with LARC treated with neoadjuvant chemoradiotherapy (CRT) followed by radical resection from January 2011 to December 2017. Patients were administered CRT, which comprised radiotherapy and chemotherapy with an oxaliplatin plus 5-fluorouracil- or fluoropyrimidine-based regimen. Clinical factors were correlated with treatment response. The multivariate logistic regression revealed that a negative nodal stage (odds ratio (OR) = 3.2, =0.0135), a high hemoglobin level (>10 g/dL) during neoadjuvant CRT (OR = 3.067, =0.0125), an oxaliplatin-containing neoadjuvant CRT (OR = 5.385, =0.0044), a long interval (>8 weeks) between radiotherapy and surgery (OR = 1.135, =0.0469), and a post-CRT CEA ≤2 ng/mL (OR = 2.891, =0.0233) were the independent predictors of increased pCR rates. The prediction nomogram was developed according to the above independent variables. The concordance index was 0.74, and the calibration curve showed good agreement. In summary, negative nodal stages, high hemoglobin levels during treatment, oxaliplatin-containing neoadjuvant therapy, a long radiotherapy-surgery interval (>8 weeks), and post-CRT CEA levels ≤2 ng/mL were favorable predictors of a pCR. This prediction nomogram might be crucial for patients with LARC undergoing a multimodality therapy.
我们旨在确定接受多模式治疗的局部晚期直肠癌（LARC）患者病理完全缓解（pCR）的预测因素。我们回顾性分析了2011年1月至2017年12月期间接受新辅助放化疗（CRT）后行根治性切除术的236例LARC患者。患者接受CRT治疗，包括放疗和以奥沙利铂加5-氟尿嘧啶或氟嘧啶为基础方案的化疗。临床因素与治疗反应相关。多因素逻辑回归显示，阴性淋巴结分期（比值比（OR）=3.2，P=0.0135）、新辅助CRT期间高血红蛋白水平（>10 g/dL）（OR=3.067，P=0.0125）、含奥沙利铂的新辅助CRT（OR=5.385，P=0.0044）、放疗与手术间隔时间长（>8周）（OR=1.135，P=0.0469）以及CRT后癌胚抗原（CEA）≤2 ng/mL（OR=2.891，P=0.0233）是pCR率增加的独立预测因素。根据上述自变量绘制了预测列线图。一致性指数为0.74，校准曲线显示一致性良好。总之，阴性淋巴结分期、治疗期间高血红蛋白水平、含奥沙利铂的新辅助治疗、放疗与手术间隔时间长（>8周）以及CRT后CEA水平≤2 ng/mL是pCR的有利预测因素。该预测列线图对接受多模式治疗的LARC患者可能至关重要。
