Zhang Chao, Zhao Shutao, Wang Xudong
Department of Gastrointestinal Nutrition and Hernia Surgery, The Second Hospital of Jilin University, Changchun, China.
Front Oncol. 2021 Dec 24;11:772482. doi: 10.3389/fonc.2021.772482. eCollection 2021.
The perioperative treatment model for locally advanced rectosigmoid junction cancer (LARSC) has not been finalized; whether this model should refer to the treatment model for rectal cancer remains controversial.
We screened 10,188 patients with stage II/III rectosigmoid junction adenocarcinoma who underwent surgery between 2004 and 2016 from the National Cancer Institute Surveillance, Epidemiology, and End Results database. Among them, 4,960 did not receive adjuvant chemotherapy, while 5,228 did receive adjuvant chemotherapy. Propensity score matching was used to balance the two groups for confounding factors, and the Kaplan-Meier method and log-rank test were used for survival analysis. Cox proportional hazards regression analysis was used to identify independent prognostic factors and build a predictive nomogram of survival for LARSC. X-tile software was used to divide the patients into three groups (low, medium, and high) according to their risk scores. 726 patients in our hospital were included for external validation.
LARSC patients did not show a benefit from neoadjuvant radiotherapy (P>0.05). After further excluding patients who received neoadjuvant radiotherapy, multivariate analysis found that age, grade, tumor size, T stage, and log odds of positive lymph nodes were independent prognostic factors for patients without adjuvant chemotherapy and were included in the nomogram. The C-index of the model was 0.690 (95% confidence interval: 0.668-0.712). We divided the patients into low, moderate, and high risk subgroups based on prediction scores of the nomogram. We found that adjuvant chemotherapy did not improve the prognosis of low risk patients, while moderate and high risk patients benefited from adjuvant therapy. External validation data found that moderate, and high risk patients also benefited from AT.
Direct surgery plus adjuvant chemotherapy may be the best perioperative treatment for LARSC. Moreover, adjuvant chemotherapy is only recommended for moderate and high risk patients as it did not benefit low risk patients.
局部晚期直肠乙状结肠交界处癌（LARSC）的围手术期治疗模式尚未确定；该模式是否应参照直肠癌的治疗模式仍存在争议。
我们从美国国立癌症研究所监测、流行病学和最终结果数据库中筛选了2004年至2016年间接受手术的10188例II/III期直肠乙状结肠交界处腺癌患者。其中，4960例未接受辅助化疗，而5228例接受了辅助化疗。采用倾向评分匹配法平衡两组的混杂因素，并使用Kaplan-Meier法和对数秩检验进行生存分析。采用Cox比例风险回归分析确定独立预后因素，并构建LARSC生存预测列线图。使用X-tile软件根据风险评分将患者分为三组（低、中、高）。纳入我院726例患者进行外部验证。
LARSC患者未显示出新辅助放疗的益处（P>0.05）。在进一步排除接受新辅助放疗的患者后，多因素分析发现年龄、分级、肿瘤大小、T分期和阳性淋巴结对数比是未接受辅助化疗患者的独立预后因素，并纳入列线图。该模型的C指数为0.690（95%置信区间：0.668-0.712）。我们根据列线图的预测评分将患者分为低、中、高风险亚组。我们发现辅助化疗并未改善低风险患者的预后，而中、高风险患者从辅助治疗中获益。外部验证数据发现，中、高风险患者也从辅助治疗中获益。
直接手术加辅助化疗可能是LARSC最佳的围手术期治疗方法。此外，仅建议中、高风险患者接受辅助化疗，因为低风险患者未从中获益。
