黏液性腺癌预测局部晚期直肠癌患者预后不良：来自 3 项前瞻性研究的个体参与者数据的汇总分析。
Mucinous Adenocarcinoma Predicts Poor Response and Prognosis in Patients With Locally Advanced Rectal Cancer: A Pooled Analysis of Individual Participant Data From 3 Prospective Studies.
机构信息
Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong, P.R. China.
Department of Medical Oncology, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China.; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou, Guangdong, P.R. China.
出版信息
Clin Colorectal Cancer. 2021 Dec;20(4):e240-e248. doi: 10.1016/j.clcc.2021.06.004. Epub 2021 Jun 26.
PURPOSE
To evaluate the predictive implications and prognosis of mucinous adenocarcinoma (MAC) in locally advanced rectal cancer (LARC) with intensified neoadjuvant treatment.
METHODS
Individual patient data of LARC patients from 3 prospective clinical trials was analyzed. Neoadjuvant treatment regimens comprised chemoradiotherapy (CRT) with fluorouracil (5-FU) or mFOLFOX6, neoadjuvant chemotherapy alone with mFOLFOX6 or mFOLFOXIRI. The postoperative pathological result, local recurrence and disease-free survival (DFS) were retrospectively analyzed in patients with MAC and adenocarcinoma (AC) with neoadjuvant treatment.
RESULTS
Totally, 743 patients were recruited, with 620 patients eligible for analysis. Fifty-three (8.5%) patients were MAC. The pathological complete response (pCR) rate and tumor downstaging rate (ypStage 0-I) between MAC and AC patients was 7.5% vs. 22.0% (P = .01) and 20.8% vs. 48.7% (P < .001), respectively. Among patients receiving preoperative CRT with 5FU or mFOLFOX6, the pCR rate and tumor downstaging rate between MAC and AC patients was 11.1% vs. 27.3% (P = .03) and 23.7% vs. 52.6% (P = .001), respectively. Regarding neoadjuvant chemotherapy alone with mFOLFOX6 or mFOLFOXIRI, the pCR rate and tumor downstaging rate was 0 vs.13.2% (P = .11) and 11.8% vs. 42.5% (P = .03) between MAC and AC group, respectively. With the median follow-up time of 38.9 months, the 3-year DFS and 3-year locoregional recurrence rate was 58.4% vs. 77.6% (P = .02) and 26.0% vs. 5.7% (P = .001) in the MAC and AC group, respectively. MAC (hazard ratio [HR] 1.85, 95% confidence interval [CI], 1.15-2.98), PNI (HR 3.23, 95% CI, 1.85-5.72) and LVI (HR 2.04, 95% CI, 1.02-4.08) were independent prognosis factors and were associated with worse DFS.
CONCLUSIONS
Patients with MAC of the rectum are associated with a lower pCR rate and tumor downstaging rate, higher incidence of local recurrence, and poorer DFS with neoadjuvant treatment.
目的
评估强化新辅助治疗局部晚期直肠癌（LARC）中黏液腺癌（MAC）的预测意义和预后。
方法
分析了 3 项前瞻性临床试验中 LARC 患者的个体患者数据。新辅助治疗方案包括氟尿嘧啶（5-FU）或 mFOLFOX6 联合放化疗（CRT），或 mFOLFOX6 或 mFOLFOXIRI 联合新辅助化疗。回顾性分析了 MAC 和腺癌（AC）患者新辅助治疗后的术后病理结果、局部复发和无病生存（DFS）。
结果
共纳入 743 例患者，其中 620 例符合分析条件。53 例（8.5%）患者为 MAC。MAC 患者的病理完全缓解（pCR）率和肿瘤降期率（ypStage 0-I）分别为 7.5%和 22.0%（P=0.01）和 20.8%和 48.7%（P<0.001）。在接受术前 CRT 联合 5FU 或 mFOLFOX6 的患者中，MAC 和 AC 患者的 pCR 率和肿瘤降期率分别为 11.1%和 27.3%（P=0.03）和 23.7%和 52.6%（P<0.001）。在接受 mFOLFOX6 或 mFOLFOXIRI 新辅助化疗的患者中，pCR 率和肿瘤降期率分别为 0%和 13.2%（P=0.11）和 11.8%和 42.5%（P=0.03）。中位随访时间为 38.9 个月，MAC 和 AC 组的 3 年 DFS 和 3 年局部区域复发率分别为 58.4%和 77.6%（P=0.02）和 26.0%和 5.7%（P=0.001）。MAC（风险比[HR]1.85，95%置信区间[CI]1.15-2.98）、PNI（HR 3.23，95%CI 1.85-5.72）和 LVI（HR 2.04，95%CI 1.02-4.08）是独立的预后因素，与较差的 DFS 相关。
结论
直肠 MAC 患者的 pCR 率和肿瘤降期率较低，局部复发率较高，DFS 较差，新辅助治疗后。
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