Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
BMC Cancer. 2024 Oct 9;24(1):1248. doi: 10.1186/s12885-024-12972-6.
Locally advanced rectal cancer (LARC) poses unique challenges in treatment, with current neoadjuvant chemoradiotherapy (NA-CRT) showing limitations. The CapeOX regimen emerges as a potential less aggressive neoadjuvant chemotherapy (NAC) for LARC.
We conducted a retrospective study involving treatment-naïve patients with LARC from March 2014 to March 2021 who received 2-4 cycles of CapeOX NAC followed by radical surgery. Treatment response was evaluated using tumor regression grade (TRG), MRI-based TRG (MRI-TRG), and Neoadjuvant Rectal (NAR) score.
94.7% of patients experienced symptom improvement and 96.4% achieved sphincter-preserving surgery. Post-NAC showed significant tumor regression and MRI confirmed a tumor length reduction (P < 0.001). Clinical and pathological staging discrepancies post-NAC suggest broader therapeutic advantages. 5-year overall and disease-free survival rates were 78.4% and 73.4%. NAR scores provided better prognostic accuracy than MRI-TRG.
CapeOX NAC presents notable benefits for LARC patients and its clinical significance may be underestimated. The NAR score demonstrates superior prognostic value over MRI-TRG.
局部晚期直肠癌（LARC）在治疗方面存在独特的挑战，目前的新辅助放化疗（NA-CRT）显示出局限性。CapeOX 方案作为 LARC 的一种潜在侵袭性较小的新辅助化疗（NAC）出现了。
我们进行了一项回顾性研究，纳入了 2014 年 3 月至 2021 年 3 月期间接受 2-4 个周期 CapeOX NAC 治疗后行根治性手术的 LARC 初治患者。采用肿瘤退缩分级（TRG）、基于 MRI 的 TRG（MRI-TRG）和新辅助直肠（NAR）评分评估治疗反应。
94.7%的患者症状改善，96.4%的患者行保肛手术。NAC 后肿瘤明显退缩，MRI 证实肿瘤长度减少（P<0.001）。NAC 后临床和病理分期的差异提示其具有更广泛的治疗优势。5 年总生存率和无病生存率分别为 78.4%和 73.4%。NAR 评分比 MRI-TRG 提供更好的预后准确性。
CapeOX NAC 对 LARC 患者具有显著益处，其临床意义可能被低估。NAR 评分比 MRI-TRG 具有更高的预后价值。
