Li Yue-Gang, Han Cheng-Cheng, Zhuang Meng, Zhao Wei, Hu Gang, Qiu Wen-Long, Wang Xi-Shan, Tang Jian-Qiang
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.
World J Gastrointest Surg. 2025 Jan 27;17(1):98263. doi: 10.4240/wjgs.v17.i1.98263.
Endoscopy allows for the direct observation of primary tumor characteristics and responses after neoadjuvant treatment. However, reports on endoscopic evaluation following neoadjuvant immunotherapy remain limited.
To examine the predictive value of endoscopic findings of primary tumors for responses to neoadjuvant immunotherapy.
This retrospective study, conducted at a tertiary center in China, evaluated 74 patients with colorectal cancer, including 17 with deficient mismatch repair (dMMR) and 15 with proficient mismatch repair (pMMR) tumors. Patients underwent neoadjuvant immunotherapy followed by surgery. Endoscopic findings before and after neoadjuvant immunotherapy were reviewed and compared with the pathology of the resected specimens.
In the pMMR group ( = 57 evaluable patients), endoscopy identified 11/17 patients who achieved a complete response (CR), while misidentifying 1/40 patients with residual disease as CR (64.7% 2.5%, < 0.01). Conversely, 22/40 patients with residual disease were accurately identified as achieving a partial response (PR), with 1/17 patients who achieved CR misclassified as PR (55.0% 5.9%, < 0.01). The sensitivity, specificity, and accuracy of endoscopic diagnosis for pathological CR were 64.7%, 97.5%, and 87.7%, respectively. In the dMMR cohort, endoscopy classified 9/17 patients as CR and 2 of the remaining patients with residual tumors as PR (64.3% 66.7%, = 0.73). The method demonstrated 100% sensitivity and 82.4% accuracy in diagnosing pathological CR.
Endoscopic evidence of CR or PR was well correlated with postoperative pathological outcomes in the pMMR cohort. Despite endoscopic indications of tumor residue, a complete pathological response post-surgery was possible in the dMMR cohort.
内镜检查可直接观察原发性肿瘤特征及新辅助治疗后的反应。然而，关于新辅助免疫治疗后内镜评估的报道仍然有限。
探讨原发性肿瘤内镜检查结果对新辅助免疫治疗反应的预测价值。
本回顾性研究在中国一家三级中心进行，评估了74例结直肠癌患者，其中17例为错配修复缺陷（dMMR）肿瘤，15例为错配修复 proficient（pMMR）肿瘤。患者接受新辅助免疫治疗后进行手术。回顾新辅助免疫治疗前后的内镜检查结果，并与切除标本的病理结果进行比较。
在pMMR组（n = 57例可评估患者）中，内镜检查识别出11/17例达到完全缓解（CR）的患者，同时将1/40例有残留疾病的患者误判为CR（64.7% ± 2.5%，P < 0.01）。相反，22/40例有残留疾病的患者被准确识别为达到部分缓解（PR），1/17例达到CR的患者被误分类为PR（55.0% ± 5.9%，P < 0.01）。内镜诊断病理CR的敏感性、特异性和准确性分别为64.7%、97.5%和87.7%。在dMMR队列中，内镜检查将9/17例患者分类为CR，其余2例有残留肿瘤的患者分类为PR（64.3% ± 66.7%，P = 0.73）。该方法在诊断病理CR时显示出100%的敏感性和82.4%的准确性。
在pMMR队列中，内镜检查显示的CR或PR与术后病理结果密切相关。尽管内镜检查提示有肿瘤残留，但dMMR队列患者术后仍可能出现完全病理缓解。
