Cabrini Monash University Department of Surgery, Cabrini Health, Malvern, VIC, 3144, Australia.
Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC, 3800, Australia.
Int J Colorectal Dis. 2020 Sep;35(9):1759-1767. doi: 10.1007/s00384-020-03633-8. Epub 2020 May 30.
Patients with locally advanced rectal cancer who achieve pathologic complete response (pCR) following neoadjuvant therapy have better long-term outcomes and could be spared from the perioperative and long-term morbidity of rectal resection. The aim of this study was to identify factors that predict the ability to achieve pCR at completion of conventional neoadjuvant therapy, therefore determining their suitability for non-surgical management.
A retrospective analysis was performed on data obtained from a prospectively maintained colorectal neoplasia database. Patients treated for biopsy-proven primary rectal adenocarcinoma between January 1, 2010, and February 28, 2018, who received neoadjuvant radiotherapy or chemoradiotherapy and had undergone surgical resection, were included in this study. Five-year oncologic outcome data was also obtained for 144 patients. Clinicopathological tumour characteristics and treatment regimens were analysed for correlation to clinical outcome.
Three hundred fifty-four patients met inclusion criteria for this study. We identified significant differences between patients achieving a pCR and those that did not for tumour type (adenocarcinoma vs. mucinous/signet ring; p = 0.008), pre-treatment serum CEA level (</≥ 2.5 μg/L; p = 0.003), neoadjuvant therapy type (short-course radiotherapy and long-course chemoradiotherapy; p = 0.008) and preoperative lymph node status (node-negative versus node-positive disease; p = 0.031). Additionally, this is the first report to our knowledge to identify a significant correlation with pCR and the degree of tumour fixity (mobile vs. fixed/tethered; p = 0.038).
This retrospective analysis identified factors that significantly impact a patients' ability to achieve a pCR, which may prove useful for prospectively selecting patients suitable for non-surgical management of disease.
接受新辅助治疗后达到病理完全缓解（pCR）的局部晚期直肠癌患者具有更好的长期预后，可以避免直肠切除的围手术期和长期发病率。本研究的目的是确定预测在常规新辅助治疗完成时获得 pCR 的能力的因素，从而确定其适合非手术治疗的可能性。
对 2010 年 1 月 1 日至 2018 年 2 月 28 日期间经活检证实为原发性直肠腺癌且接受新辅助放疗或放化疗并接受手术切除的患者数据进行回顾性分析。还获得了 144 例患者的 5 年肿瘤学结果数据。分析临床病理肿瘤特征和治疗方案与临床结果的相关性。
本研究共纳入 354 例符合条件的患者。我们发现，在肿瘤类型（腺癌与黏液/印戒细胞癌；p = 0.008）、治疗前血清 CEA 水平（</≥ 2.5 μg/L；p = 0.003）、新辅助治疗类型（短程放疗和长程放化疗；p = 0.008）和术前淋巴结状态（淋巴结阴性与淋巴结阳性疾病；p = 0.031）方面，pCR 患者与未达 pCR 的患者存在显著差异。此外，据我们所知，这是首次报道 pCR 与肿瘤固定程度（活动与固定/系紧；p = 0.038）显著相关。
本回顾性分析确定了影响患者获得 pCR 能力的重要因素，这可能有助于前瞻性选择适合非手术治疗疾病的患者。
