新辅助放化疗后直肠癌患者的预后分析：不同 TRG 患者的预后因素不同。
Prognostic analysis of rectal cancer patients after neoadjuvant chemoradiotherapy: different prognostic factors in patients with different TRGs.
机构信息
Division of Abdominal Tumor Multimodality Treatment, Department of Radiation Oncology, Cancer Center, State Key Laboratory of Biological Therapy, West China Hospital of Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu City, 610041, Sichuan Province, China.
出版信息
Int J Colorectal Dis. 2024 Jun 19;39(1):93. doi: 10.1007/s00384-024-04666-z.
PURPOSE
The extent of tumor regression varies widely among locally advanced rectal cancer (LARC) patients who receive neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision (TME). The purpose of this retrospectively study is to assess prognostic factors in LARC patients with NCRT, and further to analyze survival outcomes in patients with different tumor regression grades (TRGs).
METHODS
This study includes LARC patients who underwent NCRT and TME at our institution. We retrospectively analyzed the clinicopathological characteristics and survival of all patients, and performed subgroup analysis for patients with different TRGs. Survival differences were compared using the Kaplan-Meier method and the log rank test. Additionally, a multiple Cox proportional hazard model was used to identify independent prognostic factors.
RESULTS
The study included 393 patients, with 21.1%, 26.5%, 45.5%, and 6.9% achieving TRG 0, TRG 1, TRG 2, and TRG 3, respectively. The overall survival (OS) rate and disease-free survival (DFS) rate for all patients were 89.4% and 70.7%, respectively. Patients who achieved TRG 0-3 had different 5-year OS rates (96.9%, 91.1%, 85.2%, and 68.8%, P = 0.001) and 5-year DFS rates (80.8%, 72.4%, 67.0%, 55.8%, P = 0.031), respectively. Multivariate analyses showed that the neoadjuvant rectal (NAR) score was an independent prognostic indicator for both overall survival (OS) (HR = 4.040, 95% CI = 1.792-9.111, P = 0.001) and disease-free survival (DFS) (HR = 1.971, 95% CI = 1.478-2.628, P ˂ 0.001). In the subgroup analyses, the NAR score was found to be associated with DFS in patients with TRG 1 and TRG 2. After conducting multivariate analysis, it was found that ypT stage was a significant predictor of DFS for TRG 1 patients (HR = 4.384, 95% CI = 1.721-11.168, P = 0.002). On the other hand, ypN stage was identified as the dominant prognostic indicator of DFS for TRG 2 patients (HR = 2.795, 95% CI = 1.535-5.091, P = 0.001). However, none of these characteristics was found to be correlated with survival in patients with TRG 0 or TRG 3.
CONCLUSION
NAR score, in particular, appears to be the most powerful prognostic factor. It is important to consider various prognostic predictors for patients with different TRGs.
目的
接受新辅助放化疗（NCRT）后行全直肠系膜切除术（TME）的局部晚期直肠癌（LARC）患者的肿瘤退缩程度差异很大。本回顾性研究的目的是评估接受 NCRT 的 LARC 患者的预后因素，并进一步分析不同肿瘤退缩分级（TRG）患者的生存结局。
方法
本研究纳入在我院接受 NCRT 和 TME 的 LARC 患者。我们回顾性分析了所有患者的临床病理特征和生存情况，并对不同 TRG 患者进行了亚组分析。使用 Kaplan-Meier 方法和对数秩检验比较生存差异。此外，还使用多 Cox 比例风险模型来识别独立的预后因素。
结果
本研究共纳入 393 例患者，TRG 0、TRG 1、TRG 2 和 TRG 3 分别占 21.1%、26.5%、45.5%和 6.9%。所有患者的总生存（OS）率和无病生存（DFS）率分别为 89.4%和 70.7%。达到 TRG 0-3 的患者的 5 年 OS 率（96.9%、91.1%、85.2%和 68.8%，P = 0.001）和 5 年 DFS 率（80.8%、72.4%、67.0%、55.8%，P = 0.031）存在差异。多变量分析表明，新辅助直肠（NAR）评分是 OS（HR = 4.040，95%CI = 1.792-9.111，P = 0.001）和 DFS（HR = 1.971，95%CI = 1.478-2.628，P ˂ 0.001）的独立预后指标。在亚组分析中，NAR 评分与 TRG 1 和 TRG 2 患者的 DFS 相关。进行多变量分析后发现，ypT 分期是 TRG 1 患者 DFS 的显著预测因素（HR = 4.384，95%CI = 1.721-11.168，P = 0.002）。另一方面，ypN 分期是 TRG 2 患者 DFS 的主要预后指标（HR = 2.795，95%CI = 1.535-5.091，P = 0.001）。然而，在 TRG 0 或 TRG 3 患者中，均未发现这些特征与生存相关。
结论
NAR 评分似乎是最强的预后因素。对于不同 TRG 的患者，考虑各种预后预测因素很重要。
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