Sell Naomi M, Qwaider Yasmeen Z, Goldstone Robert N, Cauley Christy E, Cusack James C, Ricciardi Rocco, Bordeianou Liliana G, Berger David L, Kunitake Hiroko
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Surg Oncol. 2021 Jan;123(1):293-298. doi: 10.1002/jso.26247. Epub 2020 Oct 6.
Multimodal treatment is the standard of care for rectal adenocarcinoma, with a subset of patients achieving a pathologic complete response (pCR). While pCR is associated with improved overall survival (OS), long-term data on patients with pCR is limited.
This is a single institution retrospective cohort study of all patients with clinical stages II/III rectal adenocarcinoma who underwent neoadjuvant chemoradiation therapy and operative resection (January 1, 2004-December 31, 2017). PCR was defined as no tumor identified in the rectum or associated lymph nodes by final pathology.
Of 370 patients in this cohort, 50 had a pCR (13.5%). For pCR patients, 5-year disease-free survival (DFS) was 92%, 5-year OS was 95%. Twenty-six patients had surgery > 10 years before the study end date, of which 20 had an OS > 10 years (77%) with median OS 12.1 years and 95% alive to date (19/20). Of the 50 pCR patients, there was a single recurrence in the lung at 44.3 months after proctectomy which was surgically resected.
For patients with rectal adenocarcinoma that undergo neoadjuvant chemoradiation and surgical resection, pCR is associated with excellent long-term DFS and OS. Many patients live greater than 10 years with no evidence of disease recurrence.
多模式治疗是直肠腺癌的标准治疗方法，部分患者可实现病理完全缓解（pCR）。虽然pCR与总体生存率（OS）的改善相关，但关于pCR患者的长期数据有限。
这是一项单机构回顾性队列研究，研究对象为所有接受新辅助放化疗和手术切除的临床II/III期直肠腺癌患者（2004年1月1日至2017年12月31日）。pCR定义为最终病理检查在直肠或相关淋巴结中未发现肿瘤。
该队列中的370例患者中，50例实现了pCR（13.5%）。对于pCR患者，5年无病生存率（DFS）为92%，5年OS为95%。26例患者在研究结束日期前10年以上接受了手术，其中20例OS超过10年（77%），OS中位数为12.1年，95%至今仍存活（19/20）。在50例pCR患者中，有1例在直肠切除术后44.3个月出现肺部复发，复发灶接受了手术切除。
对于接受新辅助放化疗和手术切除的直肠腺癌患者，pCR与优异的长期DFS和OS相关。许多患者存活超过10年，无疾病复发迹象。
