From the Department of General Surgery, Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China (Feng, Zheng, Chen, Yao, Yan).
Department of Colorectal Surgery, Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (Wang, Zhao).
J Am Coll Surg. 2024 Oct 1;239(4):363-374. doi: 10.1097/XCS.0000000000001116. Epub 2024 Sep 16.
Neoadjuvant chemoradiotherapy (nCRT) for rectal cancer can lead to structural changes in collagen in the tumor microenvironment and increase the risk of postoperative anastomotic stenosis (AS). However, the quantitative relationship between AS and collagen has not been defined. This study is to quantitatively analyze the collagen features in rectal cancer and explore the relationship between the changes of collagen and postoperative anastomotic stenosis after nCRT.
This is a retrospective study. A total of 371 patients with rectal cancer were included. Collagen features in the resection margin of rectal cancer anastomosis was extracted by multiphoton imaging. The least absolute shrinkage operator logistic regression was performed to select features related to AS and the collagen score (CS) was constructed. Area under the receiver operating curve (AUROC) and decision curve analysis were performed to evaluate the discrimination and clinical benefit of the nomogram.
The probability of AS was 23% in the training cohort and 15.9% in the validation cohort. In the training cohort, the distance between tumor and resection margin, anastomotic leakage and CS were independent risk factors for postoperative AS in univariate and multivariate analyses. A nomogram was constructed based on these results. The prediction nomogram showed good discrimination (AUROC 0.864; 95% CI 0.776 to 0.952) and was validated in the validation cohort (AUROC 0.918; 95% CI 0.851 to 0.985).
CS is an independent risk factor for AS in rectal cancer after nCRT. The predictive model based on CS can predict the occurrence of postoperative AS.
新辅助放化疗（nCRT）可导致直肠癌肿瘤微环境中胶原结构发生变化，增加术后吻合口狭窄（AS）的风险。然而，AS 与胶原之间的定量关系尚未明确。本研究旨在定量分析直肠癌中的胶原特征，并探讨 nCRT 后胶原变化与术后吻合口狭窄的关系。
这是一项回顾性研究。共纳入 371 例直肠癌患者。通过多光子成像技术提取直肠癌吻合口切缘的胶原特征。采用最小绝对收缩和选择算子逻辑回归选择与 AS 相关的特征，并构建胶原评分（CS）。绘制受试者工作特征曲线（AUROC）和决策曲线分析评估列线图的判别能力和临床获益。
在训练队列中，AS 的概率为 23%，验证队列中为 15.9%。在训练队列中，肿瘤与切缘距离、吻合口漏和 CS 是术后 AS 的独立危险因素，无论是在单因素还是多因素分析中。基于这些结果构建了一个列线图。预测列线图显示出良好的判别能力（AUROC 0.864；95%CI 0.776 至 0.952），在验证队列中得到验证（AUROC 0.918；95%CI 0.851 至 0.985）。
CS 是 nCRT 后直肠癌 AS 的独立危险因素。基于 CS 的预测模型可预测术后 AS 的发生。
