新辅助放化疗对局部进展期直肠癌局部复发和远处转移模式的影响：倾向评分匹配分析。
Impact of neoadjuvant chemoradiotherapy on the local recurrence and distant metastasis pattern of locally advanced rectal cancer: a propensity score-matched analysis.
机构信息
Department of Colorectal Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
State Key Lab of Molecular Oncology, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
出版信息
Chin Med J (Engl). 2021 Sep 15;134(18):2196-2204. doi: 10.1097/CM9.0000000000001641.
BACKGROUND
Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis.
METHODS
In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed.
RESULTS
After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = -2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = -1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group.
CONCLUSIONS
The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.
背景
先前的研究表明，接受新辅助放化疗（NCRT）与未接受 NCRT 的患者之间，远处转移的主要部位不同。本研究旨在通过倾向评分匹配分析，探讨 NCRT 是否会影响直肠癌的转移模式。
方法
本研究共纳入 2008 年 1 月至 2015 年 12 月期间接受 NCRT 或术后放化疗（PCRT）的 1296 例患者。采用倾向评分匹配校正两组间基线特征的差异。在倾向评分匹配后，比较并分析转移模式，包括转移部位和时间。
结果
经倾向评分匹配后，PCRT 组有 408 例患者，NCRT 组有 245 例患者。与 PCRT 相比，NCRT 显著降低了局部复发率（4.1% vs. 10.3%，P=0.004），但远处转移率无差异（28.2% vs. 27.9%，P=0.924）。在 NCRT 组和 PCRT 组中，最常见的转移部位均为肺部，其次为肝脏。NCRT 组的局部复发和远处转移发生时间晚于 PCRT 组（中位时间：29.2[18.8，52.0]个月 vs. 18.7[13.3，30.0]个月，Z=-2.342，P=0.019；21.2[12.2，33.8]个月 vs. 16.4[9.3，27.9]个月，Z=-1.765，P=0.035）。在 PCRT 组（39/114，34.2%）和 NCRT 组（21/69，30.4%）中，远处转移主要发生在术后第 2 年。然而，NCRT 组有 20.3%（14/69）的远处转移发生在第 3 年，而 PCRT 组这一比例仅为 13.2%（15/114）。
结论
NCRT 组和 PCRT 组远处转移的主要部位均为肺部，其次为肝脏。NCRT 并未影响远处转移的主要部位，但 NCRT 组的局部复发和远处转移发生时间晚于 PCRT 组。对接受 NCRT 的患者的随访策略应进行调整，需要进行更长期的强化随访。
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