Chen Mian, Chen Junguo, Huang Jun, Liu Huashan, Cao Wuteng, Luo Shuangling, Liu Zhanzhen, Hu Huanxin, Lai Sicong, Hou Yujie, Kang Liang, Huang Liang
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Guangdong Institute of Gastroenterology, Guangzhou, Guangdong, China.
Therap Adv Gastroenterol. 2023 Jan 19;16:17562848221150306. doi: 10.1177/17562848221150306. eCollection 2023.
Deficient mismatch repair (dMMR) or microsatellite instability is one of the well-established molecular biomarkers in colorectal cancer (CRC). The efficiency of neoadjuvant chemotherapy (NAC) in locally advanced colorectal cancer (LACC) patients with dMMR is unclear.
We assessed the tumor response and clinical outcome in LACC patients with dMMR received NAC.
Retrospective, single-center analysis.
From 2013 to 2018, a total of 577 LACC patients with dMMR who underwent radical surgery were identified. Among them, 109 patients who received adjuvant chemotherapy were further screened out for analysis. According to whether receiving NAC or not, 109 patients were divided into two groups with the purpose of retrospectively analyzing their characteristics, treatment, and survival results, especially the 5-year disease-free survival (DFS) and 5-year overall survival.
Baseline characteristics were matched between the two groups. One of 40 patients in NAC group recurred, while 13 of 69 patients in non-NAC group recurred. Univariate and multivariate analyses showed that NAC (hazard ratio: 0.115; 95% confidence interval: 0.015-0.897; = 0.039) was independent influence factor for DFS. In NAC group, there were 13/40 (32.5%) patients for tumor regression grade 1 and 27/40 (67.5%) patients converted clinical positive N-stage into negative N-stage.
In this study, NAC was associated with better tumor downstaging and longer 5-year DFS in LACC patients with dMMR. Consequently, NAC might be an additional treatment choice when it comes to such patients in the future.
错配修复缺陷（dMMR）或微卫星不稳定性是结直肠癌（CRC）中已确立的分子生物标志物之一。新辅助化疗（NAC）在错配修复缺陷的局部晚期结直肠癌（LACC）患者中的疗效尚不清楚。
我们评估了接受NAC的错配修复缺陷的LACC患者的肿瘤反应和临床结局。
回顾性单中心分析。
2013年至2018年，共确定了577例接受根治性手术的错配修复缺陷的LACC患者。其中，进一步筛选出109例接受辅助化疗的患者进行分析。根据是否接受NAC，将109例患者分为两组，旨在回顾性分析其特征、治疗和生存结果，尤其是5年无病生存率（DFS）和5年总生存率。
两组之间的基线特征相匹配。NAC组40例患者中有1例复发，而非NAC组69例患者中有13例复发。单因素和多因素分析表明，NAC（风险比：0.115；95%置信区间：0.015 - 0.897；P = 0.039）是DFS的独立影响因素。在NAC组中，有13/40（32.5%）例患者肿瘤退缩分级为1级和2级，27/40（67.5%）例患者临床阳性N分期转为阴性N分期。
在本研究中，NAC与错配修复缺陷的LACC患者更好的肿瘤降期和更长的5年DFS相关。因此，未来对于此类患者，NAC可能是一种额外的治疗选择。
