Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, No. 52 Fu-Cheng Road, Hai-Dian District, 100142, Beijing, People's Republic of China.
Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, 100142, China.
Int J Colorectal Dis. 2022 Nov;37(11):2321-2333. doi: 10.1007/s00384-022-04268-7. Epub 2022 Oct 15.
Reassessment tools of response to long-course neoadjuvant chemoradiation treatment (nCRT) in patients with locally advanced rectal cancer (LARC) are important in predicting complete response (CR) and thus deciding whether a wait-and-watch strategy can be implemented in these patients. Choosing which routine reassessment tools are optimal and when to use them is still unclear and will be researched in the study.
Altogether, 250 patients with LARC who received nCRT from 2013 to 2021 and were followed up were retrospectively reviewed. Common reassessment tools of response included digital rectal examination (DRE), clinical examination and symptoms, endoscopy, biopsy, magnetic resonance imaging (MRI), and blood biomarkers.
Overall, 27.20% (68/250) patients had a complete response and 72.80% (182/250) did not. The combination of MRI, endoscopy, and biopsy showed the best performance in terms of accuracy of 74% and area under the curve (AUC, 0.714, 95% CI 0.546-0.882). Reassessing through DRE and presence of symptoms failed to improve the efficacy of response reassessment. After 100 days, biopsy as an assessment tool would obtain a substantial rise in accuracy from 51.28 to 100% (p = 0.003).
The combination of MRI, endoscopy, and biopsy is suitable as the reassessment tool of response for applying a wait-and-watch strategy after long-course nCRT in patients with LARC. The accuracy of biopsy as reassessment tools would be improved if they were used over 100 days after nCRT in patients with rectal cancer.
在局部晚期直肠癌(LARC)患者中,对长程新辅助放化疗(nCRT)治疗反应的评估工具对于预测完全缓解(CR)非常重要,从而决定是否可以对这些患者实施观察等待策略。选择哪些常规评估工具最优以及何时使用这些工具仍不明确,这将在研究中进行研究。
回顾性分析了 2013 年至 2021 年接受 nCRT 并随访的 250 例 LARC 患者。常用的反应评估工具包括直肠指检(DRE)、临床检查和症状、内镜、活检、磁共振成像(MRI)和血液生物标志物。
总体而言,68/250(27.20%)例患者完全缓解,182/250(72.80%)例患者未缓解。MRI、内镜和活检的联合应用在准确性方面表现最佳,准确率为 74%,曲线下面积(AUC)为 0.714(95%CI 0.546-0.882)。通过 DRE 和症状重新评估未能提高反应重新评估的效果。在 100 天后,活检作为一种评估工具的准确性会从 51.28%显著提高到 100%(p=0.003)。
MRI、内镜和活检的联合应用适用于 LARC 患者长程 nCRT 后应用观察等待策略的反应评估工具。在 nCRT 后 100 天以上使用活检作为评估工具,可以提高准确性。