Chuang Jen-Pin, Tsai Hsiang-Lin, Chen Po-Jung, Huang Ching-Wen, Su Wei-Chih, Chang Tsung-Kun, Chen Yen-Cheng, Li Ching-Chun, Yeh Yung-Sung, Wang Jaw-Yuan
Department of Surgery, Chiayi Hospital, Ministry of Health and Welfare, Chiayi City, Taiwan.
Department of Surgery, Faculty of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Kaohsiung J Med Sci. 2025 Jun;41(6):e70008. doi: 10.1002/kjm2.70008. Epub 2025 Mar 13.
Neoadjuvant chemoradiotherapy (NACRT) is the standard treatment for patients with locally advanced rectal cancer (LARC). Tumor regression grade (TRG) is an essential prognostic factor in determining treatment efficacy. However, the potential factors influencing TRG in patients with rectal cancer who have received NACRT have not been investigated. We conducted a retrospective analysis of patients with LARC who received NACRT followed by surgical resection. We collected data on the patient characteristics, including age, sex, comorbidities, tumor size, lymph node status, time between NACRT and surgery, and pretreatment carcinoembryonic antigen (CEA) levels. TRG was determined on the basis of a pathological assessment of resected specimens, and overall survival (OS) at 5 years was determined. Univariate and multivariate logistic regression models were employed to evaluate the association between the patient characteristics and TRG. Univariate analysis revealed that smoking and prechemoradiotherapy (pre-CRT) and preoperative CEA levels were significantly associated with TRG. In a multivariate analysis, both smoking and higher pre-CRT CEA levels were identified as significant predictors of a high TRG. The hazard ratios were 2.32 (95% confidence interval [CI]: 1.06-5.07, p = 0.036) for smoking and 3.1 (95% CI: 1.69-5.68, p < 0.001) for higher pre-CRT CEA levels. In Kaplan-Meier analysis, the nonsmoker group exhibited higher OS (p = 0.004). Elevated pre-CRT CEA levels and current smoking status were associated with a more than two fold increase in the risk of a higher TRG after NACRT. Moreover, smoking was a significant risk factor for poor OS in patients with LARC following NACRT.
新辅助放化疗（NACRT）是局部晚期直肠癌（LARC）患者的标准治疗方法。肿瘤退缩分级（TRG）是确定治疗效果的重要预后因素。然而，对于接受NACRT的直肠癌患者中影响TRG的潜在因素尚未进行研究。我们对接受NACRT后行手术切除的LARC患者进行了回顾性分析。我们收集了患者特征数据，包括年龄、性别、合并症、肿瘤大小、淋巴结状态、NACRT与手术之间的时间以及术前癌胚抗原（CEA）水平。根据切除标本的病理评估确定TRG，并确定5年总生存期（OS）。采用单因素和多因素逻辑回归模型评估患者特征与TRG之间的关联。单因素分析显示，吸烟、放化疗前（pre-CRT）和术前CEA水平与TRG显著相关。在多因素分析中，吸烟和较高的pre-CRT CEA水平均被确定为高TRG的显著预测因素。吸烟的风险比为2.32（95%置信区间[CI]：1.06 - 5.07，p = 0.036），较高的pre-CRT CEA水平的风险比为3.1（95%CI：1.69 - 5.68，p < 0.001）。在Kaplan-Meier分析中，非吸烟组的OS更高（p = 0.004）。pre-CRT CEA水平升高和当前吸烟状态与NACRT后高TRG风险增加两倍以上相关。此外，吸烟是NACRT后LARC患者OS不良的显著危险因素。
