Yacoub Haythem, Zenzri Yosr, Cherif Dhouha, Ben Mansour Hajer, Attia Najla, Mokrani Cyrine, Ben Zid Khadija, Letaief Feryel, Maamouri Nadia, Mezlini Amel
Gastroenterolgy department, La Rabta Hospital, Tunis, Tunisia.
Faculty of Medicine of Tunis, El Manar university, Tunis, Tunisia.
BMC Gastroenterol. 2025 Mar 31;25(1):208. doi: 10.1186/s12876-025-03709-1.
Total neoadjuvant treatment (TNT) has become a standard treatment approach for locally advanced rectal cancer (LARC). Patients achieving pathological complete response (pCR) following TNT have better outcomes (overall survival, relapse free survival). However, not all patients treated for LARC with neoadjuvant treatment achieve pCR.
The aim of our study was to assess the rate and predictors of pCR.
We performed a retrospective study at medical oncology unit in a tertiary care teaching hospital. All consecutive LARC patients without any evidence of distant metastasis who underwent neoadjuvant chemoradiotherapy and surgery between June 2020 and January 2023 were included in the research. Pathological response to neoadjuvant treatment was assessed using Mandard grading system and response was categorized as pCR or not‑pCR. Two different standardized protocols for the neoadjuvant treatment were used: the first group was treated with induction chemotherapy followed by short course radiotherapy and the second group was treated with the RAPIDO protocol. Correlation between different studied parameters and pCR was determined using univariate and multivariate logistic regression analysis.
The mean age of the 91 included patients (46 men and 45 women) was 58.53 ± 10.3 years. Twenty (22%) were found to have a pCR (Mandard TRG1) in the operative specimen. In univariate analysis, patients less than 60 years, continuation of chemotherapy and patients treated with the induction chemotherapy followed by short course radiotherapy showed a better pCR as compared to patients treated with Rapido protocol (p = 0.043, p = 0.0001 and p = 0.021 respectively). Patients with mucinous component had low pCR rates (p = 0.021). On logistic regression analysis, chemotherapy continuation (OR = 10.27, 95% CI = 2,14-49.32), and absence of mucinous component (OR = 12.6, 95% CI = 3.1-40.32) were significant predictors of pCR. The median survival was 37.7 months.
Mucinous component and chemotherapy interruption are associated with lower pCR rates. Integrating these factors into personalized treatment algorithms may help optimize therapeutic strategies and improve outcomes for patients with LARC.
全新辅助治疗（TNT）已成为局部晚期直肠癌（LARC）的标准治疗方法。接受TNT后达到病理完全缓解（pCR）的患者有更好的预后（总生存期、无复发生存期）。然而，并非所有接受新辅助治疗的LARC患者都能达到pCR。
本研究的目的是评估pCR的发生率及预测因素。
我们在一家三级医疗教学医院的肿瘤内科进行了一项回顾性研究。纳入2020年6月至2023年1月期间所有连续的、无远处转移证据且接受了新辅助放化疗及手术的LARC患者。使用曼德尔分级系统评估新辅助治疗的病理反应，并将反应分为pCR或非pCR。采用两种不同的标准化新辅助治疗方案：第一组先接受诱导化疗，随后接受短程放疗，第二组采用RAPIDO方案治疗。使用单因素和多因素逻辑回归分析确定不同研究参数与pCR之间的相关性。
纳入的91例患者（46例男性和45例女性）的平均年龄为58.53±10.3岁。在手术标本中发现20例（22%）达到pCR（曼德尔TRG1）。在单因素分析中，与接受RAPIDO方案治疗的患者相比，年龄小于60岁、继续化疗以及先接受诱导化疗后接受短程放疗的患者pCR情况更好（分别为p = 0.043、p = 0.0001和p = 0.021）。有黏液成分的患者pCR率较低（p = 0.021）。在逻辑回归分析中，继续化疗（OR = 10.27，95% CI = 2.14 - 49.32）和无黏液成分（OR = 12.6，95% CI = 3.1 - 40.32）是pCR的显著预测因素。中位生存期为37.7个月。
黏液成分和化疗中断与较低的pCR率相关。将这些因素纳入个性化治疗算法可能有助于优化治疗策略并改善LARC患者的预后。
