Fan Austin, Zhao Beiqun, Vu Peter, Abbadessa Benjamin, Lopez Nicole, Eisenstein Samuel, Ramamoorthy Sonia, Liu Shanglei
Department of Surgery, Division of Colon and Rectal Surgery, School of Medicine, University of California, San Diego, CA 92093, USA.
Department of Surgery, Division of Colon and Rectal Surgery, University of California, San Diego, CA 92093, USA.
J Clin Med. 2024 Jan 29;13(3):781. doi: 10.3390/jcm13030781.
Total neoadjuvant therapy (TNT) is the recommended treatment for locally advanced rectal cancer. The optimal sequence of TNT is debated: induction (chemotherapy first) or consolidation (chemoradiation first)? We aim to evaluate the practice patterns and clinical outcomes of total neoadjuvant therapy with either induction or consolidation regiments in the United States for patients with locally advanced rectal cancer.
This is a retrospective analysis of the National Cancer Database for patients with clinical stage II or stage III rectal cancer, diagnosed between 2006 and 2017, who underwent total neoadjuvant therapy followed by surgery.
From 2006 to 2017, we identified 8999 patients and found that the utilization of induction chemotherapy increased from 2.0% to 35.0%. TNT resulted in pathologic downstaging 46.7% of the time and a pathologic complete response 11.6% of the time. Induction chemotherapy lead to higher pathologic downstaging (58% vs. 44.7%, < 0.001) and pathologic complete responses (16.8% vs. 10.7%, < 0.001). Similar trends held true in a multivariate analysis and subset analysis of stage II and III disease.
These findings suggest that induction chemotherapy may be preferred over consolidation chemotherapy when downstaging prior to oncologic resection is desired. The optimal treatment plan for total neoadjuvant therapy is multi-factorial and requires further elucidation.
全新辅助治疗（TNT）是局部晚期直肠癌的推荐治疗方法。TNT的最佳顺序存在争议：诱导治疗（先化疗）还是巩固治疗（先放化疗）？我们旨在评估美国采用诱导或巩固方案对局部晚期直肠癌患者进行全新辅助治疗的实践模式和临床结果。
这是一项对国家癌症数据库的回顾性分析，研究对象为2006年至2017年间诊断为临床II期或III期直肠癌且接受全新辅助治疗后进行手术的患者。
2006年至2017年期间，我们共纳入8999例患者，发现诱导化疗的使用率从2.0%上升至35.0%。TNT导致46.7%的患者病理分期降低，11.6%的患者出现病理完全缓解。诱导化疗导致更高的病理分期降低率（58%对44.7%，<0.001）和病理完全缓解率（16.8%对10.7%，<0.001）。在多因素分析以及II期和III期疾病的亚组分析中也呈现出类似趋势。
这些发现表明，若希望在肿瘤切除术前降低分期，诱导化疗可能优于巩固化疗。全新辅助治疗的最佳治疗方案是多因素的，需要进一步阐明。
