Fang Yifang, Sheng Chengmin, Ding Feng, Zhao Weijie, Guan Guoxian, Liu Xing
Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Fuzhou Medical College of Nanchang University, Fuzhou, China.
Front Surg. 2022 Jan 27;8:770767. doi: 10.3389/fsurg.2021.770767. eCollection 2021.
To determine whether adding consolidation capecitabine chemotherapy without lengthening the waiting period influences pathological complete response (pCR) and short-term outcome of locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT).
Totally, 545 LARC who received NCRT and radical resection between 2010 and 2018 were enrolled. Short-term outcome and pCR rate were compared between patients with and without additional consolidation capecitabine. Logistic analysis was performed to identify predictors of pCR.
After propensity score matching, 229 patients were matched in both NCRT and NCRT-Cape groups. Postoperative morbidity was comparable between groups except for operation time, which is lower in the NCRT group (213.2 ± 67.4 vs. 227.9 ± 70.5, = 0.025). Two groups achieved similar pCR rates (21.8 vs. 22.7%, = 1.000). Tumor size (OR = 0.439, < 0.001), time interval between NCRT and surgery (OR = 1.241, = 0.003), and post-NCRT carcinoembryonic antigen (OR = 0.880, = 0.008) were significantly correlated with pCR in patients with LARC. A predictive nomogram was constructed with a C-index of 0.787 and 0.741 on internal and external validation.
Adding consolidation capecitabine chemotherapy without lengthening CRT-to-surgery interval in LARC patients after NCRT does not seem to impact pCR or short-term outcome. A predictive nomogram for pCR was successful, and it could support treatment decision-making.
确定在不延长等待期的情况下增加卡培他滨巩固化疗是否会影响接受新辅助放化疗（NCRT）的局部晚期直肠癌（LARC）的病理完全缓解（pCR）和短期预后。
共纳入2010年至2018年间接受NCRT和根治性切除术的545例LARC患者。比较接受和未接受额外卡培他滨巩固化疗患者的短期预后和pCR率。进行逻辑分析以确定pCR的预测因素。
倾向评分匹配后，NCRT组和NCRT-卡培他滨组各匹配229例患者。除手术时间外，两组术后发病率相当，NCRT组手术时间较短（213.2±67.4对227.9±70.5，P = 0.025）。两组的pCR率相似（21.8%对22.7%，P = 1.000）。肿瘤大小（OR = 0.439，P < 0.001）、NCRT与手术之间的时间间隔（OR = 1.241，P = 0.003）以及NCRT后的癌胚抗原（OR = 0.880，P = 0.008）与LARC患者的pCR显著相关。构建了预测列线图，内部验证和外部验证的C指数分别为0.787和0.741。
在NCRT后的LARC患者中，不延长CRT至手术间隔的情况下增加卡培他滨巩固化疗似乎不会影响pCR或短期预后。成功构建了pCR的预测列线图，可支持治疗决策。
