Zhang Hang, Huang Ya, Sun Ge, Zheng Kuo, Lou Zheng, Gao Xian-Hua, Hao Li-Qiang, Liu Lian-Jie, Meng Rong-Gui, Zhang Wei
Department of Colorectal Surgery, Changhai Hospital, Shanghai, China.
Department of Life Sciences, Shanghai Tech University, Shanghai, China.
Ann Transl Med. 2020 Jun;8(12):743. doi: 10.21037/atm-20-1278.
Whether adjuvant chemotherapy is beneficial for rectal cancer patients who respond well to neoadjuvant chemoradiotherapy (NCRT) and undergo radical resection is controversial. This study aimed to assess the effect of adjuvant chemotherapy on the oncological outcomes of ypT0-2N0 rectal cancer patients after NCRT and radical resection, and identify the prognostic factors.
The clinical and pathological data of rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection between January, 2010 and June, 2018 were collected and retrospectively analyzed. The oncological outcomes of the chemotherapy (chemo) group and the non-chemotherapy (non-chemo) group were compared. Multivariate analysis, using a Cox proportional hazard model, was performed to identify independent predictors of oncological outcome.
Of the 121 rectal cancer patients enrolled, 90 patients received postoperative adjuvant chemotherapy with no fewer than 3 cycles (the chemo group), and the other 31 patients with fewer than 3 cycles (the non-chemo group). There was no significant difference in the 5-year disease-free survival (DFS) or overall survival (OS) rates between the two groups (DFS: 79.1% . 82.9%, P=0.442; OS: 87.5% 78.2%, P=0.667). cT4 is an independent risk factor for OS (HR =4.227, 95% CI: 1.128-15.838, P=0.02) and DFS (HR =4.878, 95% CI: 1.752-13.578). Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT significantly improved the DFS rate (HR =0.212, 95% CI: 0.058-0.776, P=0.019).
Rectal cancer patients with ypT0-2N0 who underwent NCRT and radical resection did not benefit significantly from postoperative adjuvant chemotherapy. For these patients, cT4 was an independent risk factor for OS and DFS. Preoperative consolidation chemotherapy with Capeox or FOLFOX after NCRT can significantly improve DFS.
辅助化疗对于新辅助放化疗（NCRT）反应良好且接受根治性切除的直肠癌患者是否有益存在争议。本研究旨在评估辅助化疗对NCRT和根治性切除术后ypT0 - 2N0直肠癌患者肿瘤学结局的影响，并确定预后因素。
收集2010年1月至2018年6月期间接受NCRT和根治性切除的ypT0 - 2N0直肠癌患者的临床和病理数据，并进行回顾性分析。比较化疗组和非化疗组的肿瘤学结局。采用Cox比例风险模型进行多因素分析，以确定肿瘤学结局的独立预测因素。
在纳入的121例直肠癌患者中，90例患者接受了不少于3个周期的术后辅助化疗（化疗组），另外31例患者接受的化疗周期少于3个周期（非化疗组）。两组的5年无病生存率（DFS）或总生存率（OS）无显著差异（DFS：79.1%对82.9%，P = 0.442；OS：87.5%对78.2%，P = 0.667）。cT4是OS（HR = 4.227，95%CI：1.128 - 15.838，P = 0.02）和DFS（HR = 4.878，95%CI：1.752 - 13.578）的独立危险因素。NCRT后采用 Capeox 或 FOLFOX进行术前巩固化疗可显著提高DFS率（HR = 0.212，95%CI：0.058 - 0.776，P = 0.019）。
接受NCRT和根治性切除的ypT0 - 2N0直肠癌患者术后辅助化疗未显著获益。对于这些患者，cT4是OS和DFS的独立危险因素。NCRT后采用 Capeox 或 FOLFOX进行术前巩固化疗可显著提高DFS。
