Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine; Kaohsiung Medical University, Kaohsiung, Taiwan.
PLoS One. 2021 Nov 2;16(11):e0259460. doi: 10.1371/journal.pone.0259460. eCollection 2021.
Locally advanced colon cancer (LACC) is associated with surgical challenges during R0 resection, increased postoperative complications, and unfavorable treatment outcomes. Neoadjuvant concurrent chemoradiotherapy followed by surgical resection is an effective treatment strategy that can increase the complete surgical resection rate and improve the patient survival rate. This study investigated the efficacy and toxicity of concurrent chemoradiotherapy in patients with LACC as well as the prognosis and long-term clinical outcomes of these patients.
From January 2012 to July 2020, we retrospectively reviewed the real-world data of 75 patients with LACC who received neoadjuvant concurrent chemoradiotherapy. The chemotherapy regimen consisted of folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX). The following data were obtained from medical records: patients' characteristics, pathologic results, toxicity, and long-term oncologic outcome.
Of the 75 patients, 13 (17.3%) had pathologic complete responses. Hematologic adverse effects were the most common (grade 1 anemia: 80.0% and leukopenia: 82.7%). Conversely, grade 2 or 3 adverse effects were relatively uncommon (<10%). Pathologic N downstaging, ypT0, and pathologic complete responses were significant prognostic factors for patient survival. Multivariate analysis revealed that pathologic N downstaging was an independent predictor of patients' overall survival (P = 0.019). The estimated 5-year overall and disease-free survival rates were 68.6% and 50.6%, and the medians of overall and disease-free survival periods were 72.3 and 58.7 months, respectively. Moreover, patients with pathologic complete responses had improved overall survival (P = 0.039) and an improved local recurrence control rate (P = 0.042) but an unfavorable distant metastasis control rate (P = 0.666) in the long-term follow-up.
The long-term oncologic outcome of patients with LACC following concurrent chemoradiotherapy is acceptable, and the adverse effects seem to be tolerable. Pathologic N downstaging was an independent prognostic factor for patients' overall survival. However, a large prospective, randomized control study is required to confirm the current results.
局部晚期结肠癌（LACC）与 RO 切除术中的手术挑战、术后并发症增加以及治疗结果不佳有关。新辅助同期放化疗后行手术切除是一种有效的治疗策略，可提高完全手术切除率并提高患者生存率。本研究旨在探讨 LACC 患者同期放化疗的疗效和毒性，以及这些患者的预后和长期临床结局。
从 2012 年 1 月至 2020 年 7 月，我们回顾性分析了 75 例接受新辅助同期放化疗的 LACC 患者的真实世界数据。化疗方案为亚叶酸钙、5-氟尿嘧啶和奥沙利铂（FOLFOX）。从病历中获取以下数据：患者特征、病理结果、毒性和长期肿瘤学结局。
75 例患者中，13 例（17.3%）病理完全缓解。血液学不良反应最常见（1 级贫血：80.0%和白细胞减少症：82.7%）。相反，2 级或 3 级不良反应相对少见（<10%）。病理 N 降级、ypT0 和病理完全缓解是患者生存的显著预后因素。多因素分析显示，病理 N 降级是患者总生存的独立预测因素（P = 0.019）。估计的 5 年总生存率和无病生存率分别为 68.6%和 50.6%，总生存和无病生存期中位数分别为 72.3 和 58.7 个月。此外，在长期随访中，病理完全缓解的患者总生存（P = 0.039）和局部复发控制率（P = 0.042）改善，但远处转移控制率（P = 0.666）较差。
LACC 患者同期放化疗后的长期肿瘤学结局是可以接受的，且不良反应似乎可耐受。病理 N 降级是患者总生存的独立预后因素。然而，需要一项大型前瞻性、随机对照研究来证实目前的结果。
