糖皮质激素对局部晚期直肠癌新辅助放化疗疗效和患者生存的影响：一项回顾性研究。
Impact of glucocorticoids on the efficacy of neoadjuvant chemoradiotherapy and survival of patients with locally advanced rectal cancer: a retrospective study.
机构信息
Department of Radiation Oncology, Fujian Medical University Union Hospital, No.29 XinQuan Road, Gulou District, Fuzhou, Fujian, 350001, People's Republic of China.
Medical Technology and Engineering College of Fujian Medical University, Fuzhou, Fujian, 350001, People's Republic of China.
出版信息
BMC Cancer. 2023 Mar 14;23(1):238. doi: 10.1186/s12885-023-10592-0.
BACKGROUND
Preclinical studies suggest that glucocorticoids (GCs) promote the proliferation and development of colorectal cancer. Because GCs are broadly prescribed for treatment-related adverse events in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT), it's essential to assess the effect of GCs on clinical outcomes.
METHODS
LARC cases treated with NCRT followed by surgery were assessed retrospectively. Evaluation of the relationship between GCs use (GCs vs. non-GCs) and neoadjuvant rectal (NAR) score (as a three-level categorical dependent variable) was performed using multivariable multinomial logistic regression (MLR). We also examined the relationship between the accumulated dose of GCs and NAR using multivariate MLR. Survival analysis of disease-free survival (DFS) and overall survival (OS) was performed using the Kaplan-Meier method. Multivariate Cox regression was used to assess confounding factors that could influence OS and DFS.
RESULTS
This retrospective cohort study included 790 patients with newly diagnosed non-metastatic LARC (T3-4/N + M0) who received NCRT followed by surgery between January 2012 and April 2017. The end of the follow-up period was May 11, 2022. Among the 790 patients with LARC, 342 (43.2%) received GCs treatment and 448 (56.8%) did not during the NCRT-to-surgery period. GCs medication was significantly different between mid-NAR (8-16) and low-NAR (< 8) (odds ratio [OR], 0.615; 95% CI, 0.420-0.901; P = 0.013), and the high-NAR (> 16) and low-NAR (0.563; 0.352-0.900; 0.016). Patients exposed to GCs, had a decreased 5-year OS (GCs vs. non-GCs = 80.01% (95% CI, 75.87%-84.37%) vs. 85.30% (82.06%-88.67%), P = 0.023) and poorer 5-year DFS (73.99% (69.45%-78.82%) vs. 78.7% (75.14%-82.78%), P = 0.045). The accumulated dose of GCs was an independent risk factor for OS (hazard ratio [HR], 1.007 [1.001-1.014], 0.036) and DFS (1.010 [1.004-1.017], 0.001).
CONCLUSIONS AND RELEVANCE
Our study revealed that GCs were associated with reduced efficacy of NCRT and worse clinical outcomes in patients with LARC during the NCRT-to-surgery period.
背景
临床前研究表明，糖皮质激素（GCs）可促进结直肠肿瘤的增殖和发展。由于 GCs 广泛用于接受新辅助放化疗（NCRT）的局部晚期直肠癌（LARC）患者治疗相关不良反应，因此评估 GCs 对临床结局的影响至关重要。
方法
回顾性评估接受 NCRT 后行手术治疗的 LARC 病例。使用多变量多项逻辑回归（MLR）评估 GCs 使用（GCs 与非 GCs）与新辅助直肠（NAR）评分（作为三水平分类因变量）之间的关系。我们还使用多变量 MLR 检查 GCs 累积剂量与 NAR 之间的关系。使用 Kaplan-Meier 方法进行无病生存（DFS）和总生存（OS）的生存分析。多变量 Cox 回归用于评估可能影响 OS 和 DFS 的混杂因素。
结果
本回顾性队列研究纳入了 790 例新诊断的非转移性 LARC（T3-4/N+M0）患者，这些患者在 2012 年 1 月至 2017 年 4 月期间接受了 NCRT 联合手术治疗。随访期于 2022 年 5 月 11 日结束。在 790 例 LARC 患者中，342 例（43.2%）在 NCRT 至手术期间接受了 GCs 治疗，448 例（56.8%）未接受 GCs 治疗。GCs 治疗在中 NAR（8-16）和低 NAR（<8）之间有显著差异（比值比[OR]，0.615；95%置信区间[CI]，0.420-0.901；P=0.013），而在高 NAR（>16）和低 NAR（0.563；0.352-0.900；P=0.016）之间没有显著差异。暴露于 GCs 的患者 5 年 OS 降低（GCs 与非 GCs=80.01%（95%CI，75.87%-84.37%）与 85.30%（82.06%-88.67%），P=0.023）和 5 年 DFS 更差（73.99%（69.45%-78.82%）与 78.7%（75.14%-82.78%），P=0.045）。GCs 累积剂量是 OS（风险比[HR]，1.007[1.001-1.014]，P=0.036）和 DFS（1.010[1.004-1.017]，P=0.001）的独立危险因素。
结论和相关性
本研究表明，GCs 与 LARC 患者 NCRT 期间疗效降低和临床结局恶化相关。
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