新辅助治疗后辅助化疗对局部晚期直肠癌患者的生存获益及影响

Survival benefit and impact of adjuvant chemotherapy following neoadjuvant therapy in patients with locally advanced rectal cancer.

作者信息

Zheng Pengwen, Xu Mengzhen, Ma Dening, Feng Longhai, Qin Jing, Gao Xinyi

机构信息

Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310022, Zhejiang, China.

Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, 310022, Zhejiang, China.

出版信息

Updates Surg. 2025 Mar 19. doi: 10.1007/s13304-025-02175-4.

Abstract

The controversy surrounding the continuation of postoperative adjuvant chemotherapy (AC) for locally advanced rectal cancer patients who underwent neoadjuvant therapy (NAT) still existed. The study aimed to identify the individuals that would benefit from AC from those with stage ypII/III rectal cancer. Data for this retrospective study were obtained from the Surveillance, Epidemiology, and End Results (SEER) database and the local database. Subgroup differentiation of the beneficiary population by classification and regression tree analysis. The primary endpoint was overall survival (OS). 15,671 patients were included from the SEER database and 508 patients from local database. The proportions receiving AC were 41.9% in the SEER database and 77.6% in local database, respectively. Analysis results illustrated that the AC benefited population in the SEER database was characterized as: stage ypT4/N + patients (HR 0.75, 95% CI 0.69-0.82, p < 0.001); stage ypT3N0 patients aged 70 years or older (HR 0.69, 95% CI 0.56-0.83, p < 0.001). Moreover, stage ypT4/N + patients also significantly benefited from AC in local database (HR 0.48, 95% CI 0.31-0.74, p < 0.001). The analysis of the two databases showed that stage ypT3N0 patients aged < 70 years could not significantly benefit from AC (HR 0.90, p = 0.114 in the SEER database; HR 0.90, p = 0.960 in local database). Postoperative adjuvant chemotherapy provides a significant benefit in patients with stage ypT4/N + rectal cancer following neoadjuvant therapy. Our study discovered that locally advanced rectal cancer patients with aggressive tumors might benefit from postoperative adjuvant chemotherapy and prolonged the survival.

摘要

对于接受新辅助治疗(NAT)的局部晚期直肠癌患者,术后辅助化疗(AC)是否继续进行仍存在争议。本研究旨在从ypII/III期直肠癌患者中识别出能从AC中获益的个体。这项回顾性研究的数据来自监测、流行病学和最终结果(SEER)数据库以及本地数据库。通过分类回归树分析对受益人群进行亚组区分。主要终点是总生存期(OS)。SEER数据库纳入了15671例患者,本地数据库纳入了508例患者。SEER数据库和本地数据库中接受AC的比例分别为41.9%和77.6%。分析结果表明,SEER数据库中从AC中获益的人群特征为:ypT4/N+期患者(HR=0.75,95%CI为0.69-0.82,p<0.001);70岁及以上的ypT3N0期患者(HR=0.69,95%CI为0.56-0.83,p<0.001)。此外,ypT4/N+期患者在本地数据库中也从AC中显著获益(HR=0.48,95%CI为0.31-0.74,p<0.001)。两个数据库的分析显示,年龄<70岁的ypT3N0期患者不能从AC中显著获益(SEER数据库中HR=0.90,p=0.114;本地数据库中HR=0.90,p=0.960)。新辅助治疗后,术后辅助化疗对ypT4/N+期直肠癌患者有显著益处。我们的研究发现,具有侵袭性肿瘤的局部晚期直肠癌患者可能从术后辅助化疗中获益并延长生存期。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索