Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Cancer Rep (Hoboken). 2021 Dec;4(6):e1412. doi: 10.1002/cnr2.1412. Epub 2021 May 25.
Neoadjuvant chemotherapy (NAC) is frequently used in gastrointestinal cancers (GIC), and pathological, radiological, and tumor marker responses are assessed during and after NAC.
To evaluate the relationship between pathologic, radiologic, tumor marker responses and recurrence-free survival (RFS), overall survival (OS), adjuvant chemotherapy (AC) decisions, and the impact of changing to a different AC regimen after poor response to NAC.
Medical records of GIC patients treated with NAC at Mount Sinai between 1/2012 and 12/2018 were reviewed. One hundred fifty-six patients (58.3% male, mean age 63 years) were identified. Primary tumor sites were: 43 (27.7%) pancreas, 62 (39.7%) gastroesophageal, and 51 (32.7%) colorectal. After NAC, 31 (19.9%) patients had favorable pathologic response (FPR; defined as College of American Pathologists [CAP] score 0-1). Of 107 patients with radiological data, 59 (55.1%) had an objective response, and of 113 patients with tumor marker data, 61 (54.0%) had a ≥50% reduction post NAC. FPR, but not radiographic or serological responses, was associated with improved RFS (HR 0.28; 95% CI 0.11-0.72) and OS (HR 0.13; 95% CI 0.2-0.94). Changing to a different AC regimen from initial NAC, among all patients and specifically among those with unfavorable pathological response (UPR; defined as CAP score 2-3) after NAC, was not associated with improved RFS or OS.
GIC patients with FPR after NAC experienced significant improvements in RFS and OS. Patients with UPR did not benefit from changing AC. Prospective studies to better understand the role of pathological response in AC decisions and outcomes in GIC patients are needed.
新辅助化疗（NAC）常用于胃肠道癌症（GIC），并在 NAC 期间和之后评估病理、影像学和肿瘤标志物的反应。
评估病理、影像学、肿瘤标志物反应与无复发生存（RFS）、总生存（OS）、辅助化疗（AC）决策的关系，以及在 NAC 反应不佳后改变为不同 AC 方案的影响。
回顾了 2012 年 1 月至 2018 年 12 月在西奈山医院接受 NAC 治疗的 GIC 患者的病历。确定了 156 名患者（58.3%为男性，平均年龄 63 岁）。原发肿瘤部位为：胰腺 43 例（27.7%），胃食管 62 例（39.7%），结直肠 51 例（32.7%）。NAC 后，31 名患者（19.9%）有良好的病理反应（FPR；定义为美国病理学家学院[CAP]评分 0-1）。107 名有影像学资料的患者中，59 名（55.1%）有客观反应，113 名有肿瘤标志物资料的患者中，61 名（54.0%）NAC 后有≥50%的降低。FPR 与改善 RFS（HR 0.28；95%CI 0.11-0.72）和 OS（HR 0.13；95%CI 0.2-0.94）相关，但影像学或血清学反应则没有。在所有患者中，尤其是在 NAC 后病理反应不佳（UPR；定义为 CAP 评分 2-3）的患者中，从初始 NAC 改为不同的 AC 方案，与 RFS 或 OS 的改善无关。
NAC 后 FPR 的 GIC 患者的 RFS 和 OS 显著改善。UPR 患者从改变 AC 中没有获益。需要前瞻性研究以更好地了解病理反应在 GIC 患者的 AC 决策和结果中的作用。
