III 期直肠黏液腺癌是否受益于新辅助放化疗？
Does stage III rectal mucinous adenocarcinoma benefit from neoadjuvant chemoradiation?
机构信息
Department for Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
Department for General Surgery, University Hospital of Salzburg, Salzburg, Austria.
出版信息
Tech Coloproctol. 2024 Oct 31;28(1):146. doi: 10.1007/s10151-024-03027-w.
BACKGROUND
This study aimed to compare clinical outcomes of patients with clinical stage III mucinous rectal adenocarcinoma (M) and non-mucinous rectal adenocarcinoma (NM) and evaluate the effectiveness of neoadjuvant chemoradiation. It was hypothesized that patients with M would fare worse with neoadjuvant chemoradiation than those with NM and that patients with M and NM not receiving chemoradiation would have similar outcomes. Moreover, it was hypothesized that patients with M would have similar outcomes regardless of chemoradiation.
METHODS
This study compares eligible patients distributed in three cohorts: (cohort 1) M versus NM, including only patients treated with neoadjuvant chemoradiation; (cohort 2) M versus NM, including only patients treated without neoadjuvant chemoradiation; and (cohort 3) only M patients treated with versus without neoadjuvant chemoradiation.
RESULTS
We identified 515 patients with an average age of 58.8 (SD 12.4) years, and 30% were female. Fifty-seven (11.1%) patients had M and 458 (88.9%) had NM. Neoadjuvant chemoradiation was administered to 382 (74%) patients, of whom 41 (10.7%) were M and 341 (89.3%) NM. In cohort 1, patients with M had advanced pathological staging (stage 3: M 68% vs. NM 42%; p < 0.001), worse pathological differentiation (poor: M, 37% vs. NM, 11%; p = 0.001), more involved lymph nodes (M 0 [0;7] vs. NM 0 [0;1]; p < 0.001) and a higher rate of local recurrence (M 22% vs. 3%; p < 0.001). Patients with M demonstrated worse 7-year cancer-specific (p = 0.007) and overall survival (p = 0.01). There were no significant differences in cohort 2 and 3.
CONCLUSION
Patients with clinical stage III mucinous adenocarcinomas may not benefit as much from standard neoadjuvant chemoradiation as their non-mucinous counterparts do.
背景
本研究旨在比较临床 III 期黏液性直肠腺癌（M）和非黏液性直肠腺癌（NM）患者的临床结局，并评估新辅助放化疗的效果。假设 M 型患者接受新辅助放化疗的效果不如 NM 型患者，而不接受新辅助放化疗的 M 型和 NM 型患者的结局相似。此外，还假设 M 型患者无论是否接受放化疗，结局都相似。
方法
本研究比较了三个队列中符合条件的患者：（队列 1）M 与 NM，仅包括接受新辅助放化疗的患者；（队列 2）M 与 NM，仅包括未接受新辅助放化疗的患者；（队列 3）仅包括接受与未接受新辅助放化疗的 M 型患者。
结果
我们共纳入 515 名平均年龄为 58.8（12.4）岁的患者，其中 30%为女性。57（11.1%）例患者为 M 型，458（88.9%）例为 NM 型。382（74%）例患者接受了新辅助放化疗，其中 41（10.7%）例为 M 型，341（89.3%）例为 NM 型。在队列 1 中，M 型患者的病理分期更晚期（III 期：M 型 68%，NM 型 42%；p<0.001），病理分化更差（差：M 型 37%，NM 型 11%；p=0.001），淋巴结受累更多（M 型 0 [0-7]，NM 型 0 [0-1]；p<0.001），局部复发率更高（M 型 22%，NM 型 3%；p<0.001）。M 型患者 7 年癌症特异性生存率（p=0.007）和总生存率（p=0.01）更差。在队列 2 和 3 中，未观察到显著差异。
结论
临床 III 期黏液性腺癌患者可能不像非黏液性腺癌患者那样从标准新辅助放化疗中获益。
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