Int J Colorectal Dis. 2022 Apr;37(4):957-965. doi: 10.1007/s00384-022-04103-z. Epub 2022 Mar 24.
Management of rectal cancer with a complete clinical response (cCR) to neoadjuvant chemoradiotherapy (NACRT) is controversial. Some advocate "watch and wait" programmes and organ-preserving surgery. Central to these strategies is the ability to accurately preoperatively distinguish cCR from residual disease (RD). We sought to identify if post-NACRT (preoperative) inflammatory markers act as an adjunct to MRI and endoscopy findings for distinguishing cCR from RD in rectal cancer.
Patients from three specialist rectal cancer centres were screened for inclusion (2010-2015). For inclusion, patients were required to have completed NACRT, had a post-NACRT MRI (to assess mrTRG) and proceeded to total mesorectal excision (TME). Endoluminal response was assessed on endoscopy at 6-8 weeks post-NACRT. Pathological response to therapy was calculated using a three-point tumour regression grade system (TRG1-3). Neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), serum albumin (SAL), CEA and CA19-9 levels post-NACRT (preoperatively) were recorded. Variables were compared between those who had RD on post-operative pathology and those with ypCR. Statistical analysis was performed using SPSS (version 21).
Six hundred forty-six patients were screened, of which 422 were suitable for inclusion. A cCR rate of 25.5% (n = 123) was observed. Sixty patients who achieved cCR were excluded from final analysis as they underwent organ-preserving surgery (local excision) leaving 63 ypCR patients compared to 359 with RD. On multivariate analysis, combining cCR on MRI and endoscopy with NLR < 5 demonstrated the greatest odds of ypCR on final histological assessment [OR 6.503 (1.594-11.652]) p < 0.001]. This method had the best diagnostic accuracy (AUC = 0.962 95% CI 0.936-0.987), compared to MRI (AUC = 0.711 95% CI 0.650-0.773) or endoscopy (AUC = 0.857 95% CI 0.811-0.902) alone or used together (AUC = 0.926 95% CI 0.892-0.961).
Combining post-NACRT inflammatory markers with restaging MRI and endoscopy findings adds another avenue to aid distinguishing RD from cCR in rectal cancer.
新辅助放化疗（NACRT）后完全临床缓解（cCR）的直肠癌的治疗存在争议。一些人主张采用“观察等待”方案和保留器官的手术。这些策略的核心是能否准确地在术前区分 cCR 和残留疾病（RD）。我们旨在确定 NACRT 后（术前）炎症标志物是否可以作为 MRI 和内镜检查结果的辅助手段，用于区分直肠癌的 cCR 和 RD。
从三个直肠肿瘤专科中心筛选出符合纳入标准的患者（2010-2015 年）。纳入标准为：完成 NACRT、有 post-NACRT MRI（用于评估 mrTRG）并进行全直肠系膜切除术（TME）。NACRT 后 6-8 周进行内镜下腔内反应评估。采用三点肿瘤消退分级系统（TRG1-3）计算治疗后的病理反应。记录 NACRT 后（术前）的中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）、血清白蛋白（SAL）、CEA 和 CA19-9 水平。比较术后病理结果为 RD 和 ypCR 的患者之间的变量。使用 SPSS（版本 21）进行统计分析。
共筛选出 646 例患者，其中 422 例符合纳入标准。观察到 cCR 率为 25.5%（n=123）。由于 60 例达到 cCR 的患者接受了保留器官的手术（局部切除术），最终分析中排除了这部分患者，剩下 63 例 ypCR 患者与 359 例 RD 患者进行比较。多变量分析显示，将 MRI 和内镜检查上的 cCR 与 NLR<5 相结合，对最终组织学评估中 ypCR 的发生具有最大的优势比[OR 6.503（1.594-11.652]，p<0.001]。与 MRI（AUC=0.711，95%CI 0.650-0.773）或内镜（AUC=0.857，95%CI 0.811-0.902）单独或联合使用（AUC=0.926，95%CI 0.892-0.961）相比，该方法具有最佳的诊断准确性（AUC=0.962，95%CI 0.936-0.987）。
将 NACRT 后炎症标志物与再分期 MRI 和内镜检查结果相结合，为区分直肠癌的 RD 和 cCR 提供了另一种途径。
