Department of Radiation Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Medicine (Baltimore). 2023 Aug 25;102(34):e34985. doi: 10.1097/MD.0000000000034985.
Capecitabine-based neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for locally advanced rectal cancer. The objective of this study is to analyze overall survival (OS), disease-free survival (DFS) and prognostic factors of patients with stage II to III rectal cancer treated with nCRT in our institution. Between March 2014 to June 2020, 121 locally advanced rectal cancer patients were retrospectively reviewed and analyzed. All of the enrolled patients were treated with capecitabine-based nCRT (pelvic radiotherapy: 45-50.4 Gy, 1.8 Gy/d plus concomitant capecitabine-based chemotherapy), total mesorectal excision surgery (surgery was carried out 8-12 weeks after the end of CRT), and capecitabine-based adjuvant chemotherapy. We examined the pathological complete response rate, 3-year OS, 3-year DFS and the other prognostic factors. Kaplan-Meier method and Log-rank test were used to estimate and compare survival rate. With a median follow-up of 36 months, 3-year DFS and 3-year OS was 74.4% and 83.2%, respectively. Among the 121 patients, 24 achieved pathological complete remission (19.8%). After multivariate analysis, ypTNM stage (TNM stage after neoadjuvant therapy) was significantly associated with DFS. Positive mesorectal fasciae (MRF) status on magnetic resonance imaging and ypTNM stage were significantly related to OS. CRT with capecitabine based regimen provides high rates of survival and sphincter preservation with acceptable toxicity. YpTNM stage was significantly associated with DFS; magnetic resonance imaging MRF status and ypTNM stage were significant factors for OS after multivariate analysis. Distant metastasis is the dominant mode of treatment failure, and it is crucial to optimize systemic treatment for newly diagnosed patients.
卡培他滨为基础的新辅助放化疗（nCRT）是局部进展期直肠癌的标准治疗方法。本研究旨在分析本机构中接受 nCRT 治疗的 II 期至 III 期直肠癌患者的总生存（OS）、无病生存（DFS）和预后因素。2014 年 3 月至 2020 年 6 月，回顾性分析了 121 例局部进展期直肠癌患者。所有入组患者均接受卡培他滨为基础的 nCRT（盆腔放疗：45-50.4 Gy，1.8 Gy/d 加同期卡培他滨为基础的化疗）、全直肠系膜切除术（CRT 结束后 8-12 周进行手术）和卡培他滨为基础的辅助化疗。我们检查了病理完全缓解率、3 年 OS、3 年 DFS 和其他预后因素。Kaplan-Meier 法和 Log-rank 检验用于估计和比较生存率。中位随访 36 个月，3 年 DFS 和 3 年 OS 分别为 74.4%和 83.2%。121 例患者中，24 例达到病理完全缓解（19.8%）。多因素分析后，ypTNM 分期（新辅助治疗后 TNM 分期）与 DFS 显著相关。磁共振成像上的阳性直肠系膜筋膜（MRF）状态和 ypTNM 分期与 OS 显著相关。卡培他滨为基础的方案 CRT 提供了高生存率和可接受的毒性保留括约肌。ypTNM 分期与 DFS 显著相关；多因素分析后，磁共振成像 MRF 状态和 ypTNM 分期是 OS 的显著因素。远处转移是治疗失败的主要模式，优化新诊断患者的系统治疗至关重要。
