Yang Yanpeng, Xu Hao, Chen Guowei, Pan Yisheng
Department of Gastroenterology, Peking University First Hospital, Beijing, China.
Front Oncol. 2021 Dec 16;11:795137. doi: 10.3389/fonc.2021.795137. eCollection 2021.
Accumulated studies have verified that tumor regression is associated with the prognosis of rectal cancer. However, stratified analysis within a certain stage is still unknown. The purpose of our study was to assess the impact of pathologic response on the survival of stageII and III rectal cancer patients after neoadjuvant chemoradiotherapy (nCRT).
Clinicopathologic characteristics and tumor regression scores (TRS) were assessed in 236 rectal cancer patients who treated with nCRT followed by surgery. Survival analysis was performed using Cox proportional hazards models.
Among these patients, the stage of 88 patients was ypII, and 91 patients were with the stage of ypIII. The median follow-up time was 59.8 months. TRS was not an independent prognostic factor in ypII patients while it was significantly associated with the prognosis of ypIII patients (5-year survival rate 67.2% vs. 42.5%, < 0.001). Furthermore, ypIII patients with the response to nCRT had similar survival to that of ypII patients (5-year survival rate 67.2% vs. 70.5%, = 0.56). For ypIII patients, multivariable analysis showed that well differentiation, negative surgical margin, and the administration of adjuvant chemotherapy were associated with better survival. The surgical margin and differentiation were prognostic factors for ypII patients.
ypIII rectal cancer patients with poor response to preoperative treatment are at high risk of worse oncological outcomes.
多项研究证实肿瘤退缩与直肠癌的预后相关。然而，特定分期内的分层分析仍不清楚。本研究的目的是评估新辅助放化疗（nCRT）后病理反应对II期和III期直肠癌患者生存的影响。
对236例接受nCRT后手术的直肠癌患者的临床病理特征和肿瘤退缩评分（TRS）进行评估。使用Cox比例风险模型进行生存分析。
在这些患者中，88例为ypII期，91例为ypIII期。中位随访时间为59.8个月。TRS在ypII期患者中不是独立的预后因素，而在ypIII期患者中与预后显著相关（5年生存率67.2%对42.5%，P<0.001）。此外，对nCRT有反应的ypIII期患者与ypII期患者的生存率相似（5年生存率67.2%对70.5%，P=0.56）。对于ypIII期患者，多变量分析显示高分化、手术切缘阴性和辅助化疗的应用与更好的生存相关。手术切缘和分化是ypII期患者的预后因素。
术前治疗反应差的ypIII期直肠癌患者肿瘤学结局较差的风险较高。
