Mukai Shumpei, Sawada Naruhiko, Takehara Yusuke, Nakahara Kenta, Enami Yuta, Ishida Fumio, Kudo Shin-Ei
Digestive Disease Center, Showa University, Northern Yokohama Hospital, Yokohama, Japan.
Heliyon. 2024 Oct 18;10(20):e39530. doi: 10.1016/j.heliyon.2024.e39530. eCollection 2024 Oct 30.
Neoadjuvant therapy (NAT) before radical surgery are effective treatments for locally advanced rectal cancer. However, the treatment strategy after NAT and surgery is still unclear. It is difficult to accurately evaluate the stage before NAT, as some cases are downstaged by NAT.
We investigated the treatment strategies based on the postoperative pathology of patients with yStage Ⅰ or Ⅱ rectal cancer who underwent NAT and radical resection.
They patients were retrospectively evaluated the long-term outcomes. They were divided into patients with yStage I/II receiving NAT and patients with stage I/II patients without NAT (non-NAT). Disease-free survival (DFS) and overall survival (OS) were examined, and the prognosis was compared. Cox proportional hazard model was used to examine the recurrence risk factors in all patients or NAT. We compared the effects of adjuvant therapy in NAT.
Overall, 521 patients histologically diagnosed with yStage I/II or stage I/II who underwent surgery for rectal cancer between April 2001 and July 2019 were eligible.
The NAT and non-NAT groups included 80 and 441 patients, respectively. DFS was significantly lower in NAT, but there was no difference in OS between the two groups. All patients had several recurrence risk factors, but none of the NAT had such risk factors. No significant difference in DFS and OS was found between NAT with and without adjuvant chemotherapy.
This is a single-center retrospective study.
NAT had lower DFS than non-NAT, but no difference in OS was observed. No significant recurrence risk factors were observed in NAT. Adjuvant chemotherapy for NAT may have no benefit.
根治性手术前的新辅助治疗（NAT）是局部晚期直肠癌的有效治疗方法。然而，NAT及手术后的治疗策略仍不明确。由于部分病例经NAT后分期降低，因此术前准确评估分期较为困难。
我们基于接受NAT及根治性切除的y分期Ⅰ或Ⅱ期直肠癌患者的术后病理情况，研究其治疗策略。
对患者的长期预后进行回顾性评估。将患者分为接受NAT的y分期Ⅰ/Ⅱ期患者和未接受NAT（非NAT）的Ⅰ/Ⅱ期患者。检测无病生存期（DFS）和总生存期（OS），并比较预后情况。采用Cox比例风险模型检测所有患者或NAT患者的复发危险因素。我们比较了NAT中辅助治疗的效果。
总体而言，2001年4月至2019年7月间，521例经组织学诊断为y分期Ⅰ/Ⅱ期或Ⅰ/Ⅱ期且接受直肠癌手术的患者符合条件。
NAT组和非NAT组分别有80例和441例患者。NAT组的DFS显著较低，但两组的OS无差异。所有患者均有多个复发危险因素，但NAT组患者均无此类危险因素。接受和未接受辅助化疗的NAT患者在DFS和OS方面未发现显著差异。
这是一项单中心回顾性研究。
NAT组的DFS低于非NAT组，但OS未观察到差异。NAT组未观察到显著的复发危险因素。NAT患者进行辅助化疗可能无益处。
