Buchheit Joanna T, Janczewski Lauren M, Wells Amy, Hardy Ashley N, Abad John D, Bentrem David J, Halverson Amy L, Chawla Akhil
Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES), Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Surg Oncol. 2024 Dec;130(8):1662-1673. doi: 10.1002/jso.27839. Epub 2024 Sep 30.
The PROSPECT trial showed noninferiority of neoadjuvant chemotherapy (NAC) with selective chemoradiation (CRT) versus CRT alone. However, trial results are often difficult to reproduce with real-world data. Pathologic outcomes and overall survival (OS) were evaluated by neoadjuvant strategy in locally advanced rectal adenocarcinoma patients in a national database.
The 2012-2020 National Cancer Database was queried for clinical T2N1 and T3N0-1 rectal adenocarcinoma patients with definitive resection. Patients were categorized by neoadjuvant treatment with CRT alone, NAC alone, and NAC with CRT. Outcomes included R0 resection, pathologic complete response (PCR), and OS.
Of 18 892 patients, 16 126 (85.4%) received CRT, 1018 (5.4%) NAC, and 1748 (9.3%) NAC with CRT. Patients with NAC alone or NAC with CRT were more likely to have stage-III disease, private insurance, and academic facility treatment (all p < 0.001). NAC alone had lower adjusted odds of an R0 resection (OR 0.72; 95%CI 0.54-0.95) and PCR (OR 0.77; 95%CI 0.64-0.93). NAC with CRT demonstrated improved OS (HR 0.71; 95%CI 0.61-0.82), with no difference between NAC and CRT alone. Among patients who received adjuvant chemotherapy, no differences in OS were seen.
Patients who received NAC alone had worse pathologic outcomes. NAC had similar OS to CRT and NAC with CRT showed improved OS.
PROSPECT试验显示，新辅助化疗（NAC）联合选择性放化疗（CRT）不劣于单纯CRT。然而，试验结果往往难以用真实世界数据重现。在一个国家数据库中，采用新辅助治疗策略对局部晚期直肠腺癌患者的病理结局和总生存期（OS）进行了评估。
查询2012 - 2020年国家癌症数据库中确诊行根治性切除术的临床T2N1和T3N0 - 1直肠腺癌患者。患者按新辅助治疗方式分为单纯CRT、单纯NAC以及NAC联合CRT。结局指标包括R0切除、病理完全缓解（PCR）和OS。
18892例患者中，16126例（85.4%）接受CRT，1018例（5.4%）接受NAC，1748例（9.3%）接受NAC联合CRT。单纯NAC或NAC联合CRT的患者更可能患有III期疾病、拥有私人保险并在学术机构接受治疗（所有p < 0.001）。单纯NAC的R0切除校正比值比（OR 0.72；95%CI 0.54 - 0.95）和PCR（OR 0.77；95%CI 0.64 - 0.93）较低。NAC联合CRT显示OS改善（HR 0.71；95%CI 0.61 - 0.82），单纯NAC与单纯CRT之间无差异。在接受辅助化疗的患者中，OS无差异。
单纯接受NAC的患者病理结局较差。NAC的OS与CRT相似，NAC联合CRT显示OS改善。
