Ghalehtaki Reza, Kolahdouzan Kasra, Piozzi Guglielmo Niccolò, Rezaei Saeid, Shaka Zoha, Darzikolaee Nima Mousavi, Bayani Reyhaneh, Behboudi Behnam, Aghili Mahdi, Couñago Felipe, Sharifian Azadeh, Bagheri Farzaneh, Nazari Reza, Nabian Naeim, Babaei Mohammad, Tafti Mohsen Ahmadi, Fazeli Mohammadsadegh, Farhan Farshid
Department of Radiation Oncology, Cancer Research Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Radiation Oncology Research Center, Cancer Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
Radiat Oncol J. 2024 Dec;42(4):273-280. doi: 10.3857/roj.2024.00136. Epub 2024 Sep 19.
Treatment outcomes of locally advanced rectal cancer have improved significantly in recent decades. This retrospective study aimed to assess the efficacy of neoadjuvant chemoradiotherapy (nCRT) followed by surgery in patients with T4 rectal cancer and the different outcomes between T4a and T4b patients.
A total of 60 clinically T4 rectal cancer patients who underwent nCRT were included in the analysis. Patient characteristics, treatment regimens, down-staging rates, pathological response, and overall survival (OS) were evaluated.
Both T4a and T4b patients experienced down-staging following nCRT (36.6% and 6.2% respectively; p = 0.021). T4a patients exhibited a higher rate of pathological complete response (pCR) than T4b patients (13.3% in T4a vs. 0% in T4b; p = 0.122). After a median follow-up of 36 months, the OS and recurrence-free survival (RFS) of T4a patients were significantly higher compared to T4b patients (hazard ratio [HR] = 2.52, 95% confidence interval [CI] 1.05-6.05, p = 0.038 for OS; HR = 2.32, 95% CI 1.09-4.92, p = 0.025 for RFS).
This study provides valuable insights into the effectiveness of nCRT in T4 rectal cancer patients. Although down-staging was observed in both T4a and T4b subgroups, achieving a pCR remains a challenge, particularly in T4b patients. Further research is needed to optimize treatment strategies and enhance pCR rates in T4 rectal cancer patients to improve oncologic outcomes.
近几十年来，局部晚期直肠癌的治疗效果有了显著改善。这项回顾性研究旨在评估新辅助放化疗（nCRT）后手术治疗T4期直肠癌患者的疗效，以及T4a和T4b患者之间的不同预后。
分析纳入了60例接受nCRT的临床T4期直肠癌患者。评估患者特征、治疗方案、降期率、病理反应和总生存期（OS）。
nCRT后T4a和T4b患者均出现降期（分别为36.6%和6.2%；p = 0.021）。T4a患者的病理完全缓解（pCR）率高于T4b患者（T4a为13.3%，T4b为0%；p = 0.122）。中位随访36个月后，T4a患者的OS和无复发生存期（RFS）显著高于T4b患者（OS的风险比[HR] = 2.52，95%置信区间[CI] 1.05 - 6.05，p = 0.038；RFS的HR = 2.32，95% CI 1.09 - 4.92，p = 0.025）。
本研究为nCRT治疗T4期直肠癌患者的有效性提供了有价值的见解。尽管在T4a和T4b亚组中均观察到降期，但实现pCR仍然是一项挑战，尤其是在T4b患者中。需要进一步研究以优化治疗策略并提高T4期直肠癌患者的pCR率，从而改善肿瘤学结局。
