Department of General Surgery (Colorectal Surgery), The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510655, China.
Int J Colorectal Dis. 2024 Sep 28;39(1):153. doi: 10.1007/s00384-024-04721-9.
The role of neoadjuvant therapy (NAT) in the treatment of locally advanced rectal cancer (LARC) has been well proven, but its impact on patients who relapse remains unknown. This study aims to elucidate the influence of initial treatment and MRI-defined risk factors on postrecurrent survival in patients with LARC recurrence.
LARC patients who underwent radical surgery and subsequently developed recurrence were retrospectively identified. Patients were stratified on the basis of MRI-defined local risk assessment and the initial treatment modality for the primary tumor (NAT or primary surgery). The patients were classified into four groups: high-risk LARC with NAT (HiN), high-risk LARC with primary surgery (HiS), low-risk LARC with NAT (LoN), and low-risk LARC with primary surgery (LoS). The primary endpoint was survival after recurrence.
A total of 381 patients who experienced relapse were identified from among 2329 LARC patients. Salvage surgery was performed on 33.1% of these patients. Patients who experienced single-site recurrence or who underwent salvage surgery exhibited significantly prolonged survival times after recurrence (P < 0.001). Patients in the HiS group had poorer survival after recurrence than those in the other three groups (P = 0.034). This subset of patients, characterized by receiving less adjuvant treatment after primary surgery, had a shorter recurrence interval than those in the other groups (P = 0.001).
Our findings reaffirm the prognostic significance of salvage surgery in patients from a LARC cohort who experienced relapse. Moreover, MRI-defined high-risk LARC patients who received upfront surgery without NAT had shorter intervals of recurrence and poorer survival outcomes after recurrence. Our results highlight the critical role of NAT in improving patient survival after recurrence.
Supplementary registration was carried out at clinicaltrials.gov (Registration number: NCT06314737) on March 14, 2024. The study was retrospectively registered.
新辅助治疗（NAT）在局部晚期直肠癌（LARC）治疗中的作用已得到充分证实，但它对复发患者的影响尚不清楚。本研究旨在阐明初始治疗和 MRI 定义的危险因素对 LARC 复发患者复发后生存的影响。
回顾性确定接受根治性手术且随后复发的 LARC 患者。根据 MRI 定义的局部风险评估和原发性肿瘤的初始治疗方式（NAT 或原发性手术）对患者进行分层。患者分为以下四组：NAT 治疗的高危 LARC（HiN）、原发性手术治疗的高危 LARC（HiS）、NAT 治疗的低危 LARC（LoN）和原发性手术治疗的低危 LARC（LoS）。主要终点是复发后的生存情况。
从 2329 例 LARC 患者中确定了 381 例出现复发的患者。其中 33.1%的患者接受了挽救性手术。仅发生单部位复发或接受挽救性手术的患者复发后的生存时间明显延长（P<0.001）。与其他三组相比，HiS 组患者的复发后生存时间更差（P=0.034）。这组患者的特点是在原发性手术后接受的辅助治疗较少，与其他组相比，他们的复发间隔更短（P=0.001）。
我们的研究结果再次证实了挽救性手术在经历复发的 LARC 患者中的预后意义。此外，MRI 定义的高危 LARC 患者在未接受 NAT 的情况下接受了 upfront 手术，他们的复发间隔更短，复发后生存结局更差。我们的研究结果强调了 NAT 在改善患者复发后生存方面的关键作用。
2024 年 3 月 14 日在 clinicaltrials.gov 进行了补充注册（注册号：NCT06314737）。该研究为回顾性注册。
