Xu Yi-Jun, Tao Dan, Qin Song-Bing, Xu Xiao-Yan, Yang Kai-Wen, Xing Zhong-Xu, Zhou Ju-Ying, Jiao Yang, Wang Li-Li
Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
Department of Radiation Oncology, The Fourth Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
World J Gastrointest Oncol. 2024 Jun 15;16(6):2520-2530. doi: 10.4251/wjgo.v16.i6.2520.
Colorectal cancer is currently the third most common malignant tumor and the second leading cause of cancer-related death worldwide. Neoadjuvant chemoradiotherapy (nCRT) is standard for locally advanced rectal cancer (LARC). Except for pathological examination after resection, it is not known exactly whether LARC patients have achieved pathological complete response (pCR) before surgery. To date, there are no clear clinical indicators that can predict the efficacy of nCRT and patient outcomes.
To investigate the indicators that can predict pCR and long-term outcomes following nCRT in patients with LARC.
Clinical data of 128 LARC patients admitted to our hospital between September 2013 and November 2022 were retrospectively analyzed. Patients were categorized into pCR and non-pCR groups. Univariate analysis (using the test or Fisher's exact test) and logistic multivariate regression analysis were used to study clinical predictors affecting pCR. The 5-year disease-free survival (DFS) and overall survival (OS) rates were calculated using Kaplan-Meier analysis, and differences in survival curves were assessed with the log-rank test.
Univariate analysis showed that pretreatment carcinoembryonic antigen (CEA) level, lymphocyte-monocyte ratio (LMR), time interval between neoadjuvant therapy completion and total mesorectal excision, and tumor size were correlated with pCR. Multivariate results showed that CEA ≤ 5 ng/mL ( = 0.039), LMR > 2.73 ( = 0.023), and time interval > 10 wk ( = 0.039) were independent predictors for pCR. Survival analysis demonstrated that patients in the pCR group had significantly higher 5-year DFS rates (94.7% 59.7%, = 0.002) and 5-year OS rates (95.8% 80.1%, = 0.019) compared to the non-pCR group. Tumor deposits (TDs) were significantly correlated with shorter DFS ( = 0.002) and OS ( < 0.001).
Pretreatment CEA, LMR, and time interval contribute to predicting nCRT efficacy in LARC patients. Achieving pCR demonstrates longer DFS and OS. TDs correlate with poor prognosis.
结直肠癌是目前全球第三大常见恶性肿瘤，也是癌症相关死亡的第二大主要原因。新辅助放化疗（nCRT）是局部晚期直肠癌（LARC）的标准治疗方法。除了切除术后的病理检查外，目前尚不清楚LARC患者在手术前是否已实现病理完全缓解（pCR）。迄今为止，尚无明确的临床指标能够预测nCRT的疗效和患者预后。
探讨可预测LARC患者nCRT后pCR及长期预后的指标。
回顾性分析2013年9月至2022年11月期间我院收治的128例LARC患者的临床资料。将患者分为pCR组和非pCR组。采用单因素分析（使用检验或Fisher精确检验）和逻辑多因素回归分析来研究影响pCR的临床预测因素。采用Kaplan-Meier分析计算5年无病生存率（DFS）和总生存率（OS），并使用对数秩检验评估生存曲线的差异。
单因素分析显示，治疗前癌胚抗原（CEA）水平、淋巴细胞单核细胞比值（LMR）、新辅助治疗结束至全直肠系膜切除的时间间隔以及肿瘤大小与pCR相关。多因素分析结果显示，CEA≤5 ng/mL（P = 0.039）、LMR>2.73（P = 0.023）以及时间间隔>10周（P = 0.039）是pCR的独立预测因素。生存分析表明，与非pCR组相比，pCR组患者的5年DFS率（94.7%对59.7%，P = 0.002）和5年OS率（95.8%对80.1%，P = 0.019）显著更高。肿瘤结节（TDs）与较短的DFS（P = 0.002）和OS（P<0.001）显著相关。
治疗前CEA、LMR和时间间隔有助于预测LARC患者的nCRT疗效。实现pCR表明DFS和OS更长。TDs与预后不良相关。
