The Second Affiliated Hospital, Department of Hepatobiliary Surgery, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
The First Affiliated Hospital, Institute of Oncology, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan, China.
BMC Gastroenterol. 2024 Aug 13;24(1):263. doi: 10.1186/s12876-024-03359-9.
Neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision (TME) is the standard treatment for locally advanced rectal cancer (LARC). Mucinous adenocarcinoma (MAC) is a potential poor prognosis subgroup of rectal cancer. However, the predictive value of MAC in NCRT treatment of LARC is controversial.
A comprehensive literature search of PubMed, Embase, and the Cochrane Library was performed. All studies examining the effect of MAC on CRT response in LARC were included. Outcomes of MAC were compared with non-specific adenocarcinoma (AC) by using random-effects methods. Data were presented as odds ratios (ORs) with 95% confidence intervals (CIs). The main outcomes were the rates of pathological complete response (pCR), tumor and nodal down-staging, positive resection margin rate, local recurrence, and overall mortality.
Fifteen studies containing comparative data on outcomes in a total of 9,238 patients receiving NCRT for LARC were eligible for inclusion. MAC had a reduced rate of pCR (OR, 0.38; 95% CI, 0.18-0.78) and tumor down-staging (OR, 0.31; 95% CI, 0.22-0.44) following NCRT compared with AC. MAC did not significantly affect nodal down-staging (OR, 0.42; 95% CI, 0.16-1.12) after NCRT.
MAC of LARC was found to be a negative predictor of response to NCRT with lower rates of pCR and tumor down-staging for LARC. The nodal down-staging of MAC was relatively lower than that of AC, although the differences were not statistically significant.
新辅助放化疗（NCRT）后行全直肠系膜切除术（TME）是局部进展期直肠癌（LARC）的标准治疗方法。黏液腺癌（MAC）是直肠癌中一个具有潜在不良预后的亚组。然而，MAC 在 LARC 的 NCRT 治疗中的预测价值仍存在争议。
对 PubMed、Embase 和 Cochrane 图书馆进行全面的文献检索。纳入所有研究 MAC 对 LARC 中 CRT 反应影响的研究。采用随机效应方法比较 MAC 与非特异性腺癌（AC）的结果。数据以比值比（OR）及其 95%置信区间（CI）表示。主要结局是病理完全缓解（pCR）率、肿瘤和淋巴结降期率、阳性切缘率、局部复发率和总死亡率。
共纳入 15 项研究，包含了 9238 例接受 NCRT 治疗 LARC 的患者的结局比较数据。与 AC 相比，MAC 患者接受 NCRT 后 pCR 率（OR，0.38；95%CI，0.18-0.78）和肿瘤降期率（OR，0.31；95%CI，0.22-0.44）较低。MAC 对 NCRT 后淋巴结降期无显著影响（OR，0.42；95%CI，0.16-1.12）。
LARC 的 MAC 被发现是 NCRT 反应的负预测因子，其 pCR 和肿瘤降期率较低。MAC 的淋巴结降期率相对低于 AC，但差异无统计学意义。
