Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
Sci Rep. 2022 May 3;12(1):7145. doi: 10.1038/s41598-022-10974-7.
Patients with pathologic complete response (pCR) achievement can consider local excision or "watch and wait" strategy instead of a radical surgery. This study analyzed the predictive factors of pCR in rectal cancer patients who underwent radical operation after neoadjuvant chemoradiotherapy (nCRT). This study also analyzed the recurrence patterns in patients who achieved pCR and the oncologic outcomes and prognostic factors by ypStage. Between 2000 and 2013, 1,089 consecutive rectal cancer patients who underwent radical resection after nCRT were analyzed. These patients were classified into two groups according to pCR. The clinicopathologic and oncologic outcomes were analyzed and compared between the two groups. Multivariate analysis was conducted on factors related to pCR. The proportion of patients achieving pCR was 18.2% (n = 198). The pCR group demonstrated earlier clinical T and N stages, smaller tumor size, better differentiation, and a lower percentage of circumferential resection margin (CRM) involvement than did the non-pCR group. The prognostic factors associated with poorer disease-free survival were high preoperative carcinoembryonic antigen levels, non-pCR, poor histology, lymphatic/perineural invasion, and involvement of CRM. Multivariate analysis revealed that clinical node negativity, tumor size < 4 cm, and well differentiation were significant independent clinical predictors for achieving pCR. Patients with pCR displayed better long-term outcomes than those with non-pCR. The pCR-prediction model, based on predictive factors, is potentially useful for prognosis and for prescribing a treatment strategy in patients with advanced rectal cancer who need nCRT.
病理完全缓解(pCR)的患者可以考虑局部切除或“观察等待”策略,而不是进行根治性手术。本研究分析了接受新辅助放化疗(nCRT)后行根治性手术的直肠癌患者中 pCR 的预测因素。本研究还分析了 pCR 患者的复发模式以及ypStage 下的肿瘤学结果和预后因素。
2000 年至 2013 年间,对 1089 例接受 nCRT 后行根治性切除术的直肠癌患者进行了分析。这些患者根据 pCR 分为两组。分析并比较了两组的临床病理和肿瘤学结果。对与 pCR 相关的因素进行了多因素分析。
pCR 组的患者具有更早的临床 T 分期和 N 分期、更小的肿瘤大小、更好的分化和更低的环周切缘(CRM)受累率。与无疾病生存时间较差相关的预后因素包括术前癌胚抗原水平高、非 pCR、组织学差、淋巴/神经周围侵犯和 CRM 受累。多因素分析显示,临床淋巴结阴性、肿瘤大小<4cm 和分化良好是实现 pCR 的显著独立临床预测因素。
pCR 患者的长期预后优于非 pCR 患者。基于预测因素的 pCR 预测模型对于需要 nCRT 的晚期直肠癌患者的预后和治疗策略制定具有潜在的应用价值。