Academic Unit of Colorectal Surgery, University of Glasgow, Glasgow Royal Infirmary, Level 2, New Lister Building 10, 16 Alexandra Parade, Glasgow, G31 2ER, UK.
St Mark's Hospital and Academic Institute, London, UK.
J Cancer Res Clin Oncol. 2021 Nov;147(11):3409-3420. doi: 10.1007/s00432-021-03570-1. Epub 2021 Mar 12.
Patients with locally advanced rectal cancer (LARC) may experience a clinical complete response (cCR) to neoadjuvant chemoradiotherapy (NACRT) and opt for non-operative management. Pathological factors that relate to NACRT response have been well described. Host factors associated with response, however, are poorly defined. Calcification of the aortoiliac (AC) vessels supplying the rectum may influence treatment response.
Patients with LARC having NACRT prior to curative surgery at Glasgow Royal Infirmary (GRI) and St Mark's hospital (SMH) between 2008 and 2016 were identified. AC was scored on pre-treatment CT imaging. NACRT response was assessed using pathologic complete response (pCR) rates, tumour regression grades (TRGs), the NeoAdjuvant Rectal score and T-/N-downstaging. Associations were assessed using Chi-squared, Mantel-Haenszel and Fisher's exact tests.
Of 231 patients from GRI, 79 (34%) underwent NACRT for LARC. Most were male (58%), aged over 65 (51%) with mid- to upper rectal tumours (56%) and clinical T3/4 (95%), node-positive (77%) disease. pCR occurred in 10 patients (13%). Trends were noted between higher clinical T stage and poor response by Royal College of Pathologist's TRG (p = 0.021) and tumour height > 5 cm and poor response by Mandard TRG (0.068). In the SMH cohort, 49 of 333 (15%) patients underwent NACRT; 8 (16%) developed a pCR. AC was not associated with NACRT response in either cohort.
AC was not associated with NACRT response in this cohort. Larger contemporary cohorts are required to better assess host determinants of NACRT response and develop predictive models to improve patient selection.
局部晚期直肠癌（LARC）患者接受新辅助放化疗（NACRT）后可能出现临床完全缓解（cCR），并选择非手术治疗。与 NACRT 反应相关的病理因素已得到很好的描述。然而，与反应相关的宿主因素定义不明确。供应直肠的腹主动脉-髂动脉（AC）血管的钙化可能影响治疗反应。
在 2008 年至 2016 年间，在格拉斯哥皇家医院（GRI）和圣马克医院（SMH）接受根治性手术前接受 NACRT 的 LARC 患者被确定。在治疗前的 CT 成像上对 AC 进行评分。通过病理完全缓解（pCR）率、肿瘤消退分级（TRG）、新辅助直肠评分和 T-/N-降期来评估 NACRT 反应。使用卡方检验、Mantel-Haenszel 检验和 Fisher 精确检验评估相关性。
来自 GRI 的 231 名患者中，79 名（34%）接受了 NACRT 治疗 LARC。大多数为男性（58%），年龄超过 65 岁（51%），中高位直肠肿瘤（56%），临床 T3/4（95%），淋巴结阳性（77%）疾病。10 名患者（13%）发生 pCR。较高的临床 T 分期与皇家病理学院 TRG 较差的反应呈趋势相关（p=0.021），肿瘤高度>5cm 与 Mandard TRG 较差的反应呈趋势相关（0.068）。在 SMH 队列中，333 名患者中有 49 名（15%）接受了 NACRT；8 名（16%）发生 pCR。AC 与两个队列中的 NACRT 反应均无相关性。
在本队列中，AC 与 NACRT 反应无关。需要更大的当代队列来更好地评估 NACRT 反应的宿主决定因素，并开发预测模型以改善患者选择。
