Li Yuegang, Han Chengcheng, Cheng Yao, Hu Gang, Zhuang Meng, Wang Xishan, Tang Jianqiang
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Tech Coloproctol. 2025 Jan 16;29(1):47. doi: 10.1007/s10151-024-03088-x.
Neoadjuvant combination immunotherapy is a potential treatment option for patients with proficient mismatch repair/microsatellite stable colorectal cancer. Preoperative screening via endoscopy and imaging examinations could help identify patients who may potentially achieve a complete response after neoadjuvant combination immunotherapy. This study aims to evaluate the diagnostic accuracy of endoscopic and imaging examinations in predicting pathological complete response after neoadjuvant combination immunotherapy.
This single-center, retrospective, observational study included patients diagnosed with colorectal cancer by biopsy between 2015 and 2023 at a tertiary referral center. The main outcome measures included endoscopic examination, imaging findings, and pathological results after neoadjuvant combination immunotherapy.
This study included 36 patients with locally advanced proficient mismatch repair colorectal cancer. Postoperative pathology revealed that 17 patients (47.2%) achieved a complete response (ypT0N0). The sensitivity, specificity, and accuracy of the endoscopic ypT0N0 diagnosis were 62.5%, 80.0%, and 80.6%, respectively; those of imaging-based ypT0N0 diagnosis were 43.8%, 100%, and 75.0%, respectively; and those of the combined diagnosis were 37.5%, 100%, and 72.2%, respectively. The areas under the receiver-operating characteristic curve for the endoscopic and imaging ypT0N0 diagnoses were 0.768 and 0.706, respectively.
The specificities of endoscopy and imaging for diagnosing complete response after neoadjuvant combination immunotherapy for colorectal cancer were high; however, sensitivities were low. Therefore, radical surgery should still be recommended for patients with an incomplete response based on either examination. Larger scale studies are required to determine if a watch-and-wait strategy is suitable for patients with a complete response based on these two examinations.
新辅助联合免疫疗法是错配修复功能缺陷/微卫星稳定的结直肠癌患者的一种潜在治疗选择。通过内镜检查和影像学检查进行术前筛查有助于识别那些新辅助联合免疫疗法后可能实现完全缓解的患者。本研究旨在评估内镜检查和影像学检查在预测新辅助联合免疫疗法后病理完全缓解方面的诊断准确性。
这项单中心、回顾性观察研究纳入了2015年至2023年期间在一家三级转诊中心经活检确诊为结直肠癌的患者。主要观察指标包括新辅助联合免疫疗法后的内镜检查、影像学表现和病理结果。
本研究纳入了36例局部晚期错配修复功能缺陷的结直肠癌患者。术后病理显示，17例患者（47.2%）实现了完全缓解（ypT0N0）。内镜诊断ypT0N0的敏感性、特异性和准确性分别为62.5%、80.0%和80.6%；基于影像学诊断ypT0N0的敏感性、特异性和准确性分别为43.8%、100%和75.0%；联合诊断的敏感性、特异性和准确性分别为37.5%、100%和72.2%。内镜和影像学诊断ypT0N0的受试者工作特征曲线下面积分别为0.768和0.706。
内镜检查和影像学检查在诊断结直肠癌新辅助联合免疫疗法后完全缓解方面的特异性较高；然而，敏感性较低。因此，对于基于任何一项检查显示未完全缓解的患者，仍应建议进行根治性手术。需要开展更大规模的研究来确定观察等待策略是否适用于基于这两项检查显示完全缓解的患者。
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