Shadmanov Niyaz, Aliyev Vusal, Piozzi Guglielmo Niccolò, Bakır Barıs, Goksel Suha, Asoglu Oktar
Department of Surgery, Bogazici Academy for Clinical Sciences, Istanbul, Turkiye.
Department of General Surgery, Alibey Hospital, Istanbul, Turkiye.
Ann Coloproctol. 2025 Feb;41(1):57-67. doi: 10.3393/ac.2024.00339.0048. Epub 2025 Feb 28.
The standard treatment for locally advanced rectal cancer involves neoadjuvant chemoradiation followed by total mesorectal excision surgery. A subset of patients achieves pathologic complete response (pCR), representing the optimal treatment outcome. This study compares the long-term oncological outcomes of patients who achieved pCR with those who attained clinical complete response (cCR) after total neoadjuvant therapy, managed using a watch-and-wait approach.
This study retrospectively evaluated patients with mid-low locally advanced rectal cancer who underwent neoadjuvant treatment from January 1, 2005, to May 1, 2023. The pCR and cCR groups were compared based on demographic, clinical, histopathological, and long-term survival outcomes.
The median follow-up times were 54 months (range, 7-83 months) for the cCR group (n=73), 96 months (range, 7-215 months) for the pCR group (n=63), and 72 months (range, 4-212 months) for the pathological incomplete clinical response (pICR) group (n=627). In the cCR group, 15 patients (20.5%) experienced local regrowth, and 5 (6.8%) developed distant metastasis (DM). The pCR group had no cases of local recurrence, but 3 patients (4.8%) developed DM. Among the pICR patients, 58 (9.2%) experienced local recurrence, and 92 (14.6%) had DM. Five-year disease-free survival rates were 90.0% for cCR, 92.0% for pCR, and 69.5% for pICR (P=0.022). Five-year overall survival rates were 93.1% for cCR, 92.0% for pCR, and 78.1% for pICR. There were no significant differences in outcomes between the cCR and pCR groups (P=0.810); however, the pICR group exhibited poorer outcomes (P=0.002).
This study shows no significant long-term oncological differences between patients who exhibited cCR and those who experienced pCR.
局部晚期直肠癌的标准治疗包括新辅助放化疗，随后进行全直肠系膜切除术。一部分患者实现了病理完全缓解（pCR），这代表了最佳治疗结果。本研究比较了在接受新辅助治疗后达到pCR的患者与采用观察等待方法管理的达到临床完全缓解（cCR）的患者的长期肿瘤学结局。
本研究回顾性评估了2005年1月1日至2023年5月1日期间接受新辅助治疗的中低位局部晚期直肠癌患者。基于人口统计学、临床、组织病理学和长期生存结局对pCR组和cCR组进行比较。
cCR组（n = 73）的中位随访时间为54个月（范围7 - 83个月），pCR组（n = 63）为96个月（范围7 - 215个月），病理不完全临床缓解（pICR）组（n = 627）为72个月（范围4 - 212个月）。在cCR组中，15例患者（20.5%）出现局部复发，5例（6.8%）发生远处转移（DM）。pCR组无局部复发病例，但3例患者（4.8%）发生DM。在pICR患者中，58例（9.2%）出现局部复发，92例（14.6%）发生DM。cCR组、pCR组和pICR组的5年无病生存率分别为90.0%、92.0%和69.5%（P = 0.022）。5年总生存率分别为93.1%、92.0%和78.1%。cCR组和pCR组之间的结局无显著差异（P = 0.810）；然而，pICR组的结局较差（P = 0.002）。
本研究表明，表现出cCR的患者与经历pCR的患者在长期肿瘤学方面无显著差异。
