Catal Tuba Kurt, Can Günay, Demı Rel İsmaı L Fatı H, Ergen Sefika Arzu, Öksüz Dı dem Colpan
Department of Radiation Oncology, Necip Fazıl City Hospital, 46080 Kahramanmaras, Turkey.
Department of Public Health, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, 34098 Istanbul, Turkey.
Oncol Lett. 2025 Mar 26;29(5):249. doi: 10.3892/ol.2025.14995. eCollection 2025 May.
The present study aimed to investigate clinicopathological factors affecting local recurrence and survival in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and to create a risk-scoring model predicting local control (LC) and survival. The clinical and pathological data of 115 patients who received nCRT for LARC between February 2010 and December 2020 were reviewed retrospectively. A risk-scoring model was developed to predict LC and survival using statistically significant prognostic factors in univariate and multivariate analyses. In the multivariate analysis, the LC rate was improved in patients with a good pathological response to nCRT. By contrast, the disease-free survival (DFS) rate was significantly worse in patients with perineural invasion (PNI). The overall survival (OS) rate was significantly worse in patients who were >60 years of age, who had tumors ≥5 cm, who were PNI-positive and who had pathological N2 stage disease. Patients were grouped to analyze the ability of the scoring system to predict LC and survival. The total score was derived by assigning points to the prognostic factors in univariate and multivariate analyses and was subsequently divided into three groups according to tertile. The median LC times in groups 1-3 were significantly different at 143.6, 97.2 and 93.6 months, respectively. The median DFS times in groups 1-3 were significantly different at 136.1, 108.5 and 67.2 months, respectively, while the median OS times in groups 1-3 were significantly different at 138.3, 87.2 and 64.6 months, respectively. In conclusion, risk score modeling with prognostic factors effectively determined the difference in LC and survival between the groups. Adding effective systemic therapy to nCRT may improve results, especially in patients with multiple poor prognostic factors, including larger tumors, PNI and multiple nodal involvement.
本研究旨在探讨影响局部晚期直肠癌（LARC）患者接受新辅助放化疗（nCRT）后局部复发和生存的临床病理因素，并创建一个预测局部控制（LC）和生存的风险评分模型。回顾性分析了2010年2月至2020年12月期间115例接受nCRT治疗的LARC患者的临床和病理数据。利用单因素和多因素分析中具有统计学意义的预后因素，建立了一个预测LC和生存的风险评分模型。在多因素分析中，对nCRT病理反应良好的患者LC率有所提高。相比之下，神经周围侵犯（PNI）患者的无病生存（DFS）率明显更差。年龄>60岁、肿瘤≥5 cm、PNI阳性且病理分期为N2期的患者总生存（OS）率明显更差。将患者分组以分析评分系统预测LC和生存的能力。通过对单因素和多因素分析中的预后因素进行评分得出总分，随后根据三分位数将其分为三组。第1 - 3组的中位LC时间分别为143.6、97.2和93.6个月，差异有统计学意义。第1 - 3组的中位DFS时间分别为136.1、108.5和67.2个月，差异有统计学意义，而第1 - 3组的中位OS时间分别为138.3、87.2和64.6个月，差异有统计学意义。总之，利用预后因素进行风险评分建模有效地确定了各组之间LC和生存的差异。在nCRT基础上增加有效的全身治疗可能会改善结果，特别是对于具有多种不良预后因素的患者，包括较大肿瘤、PNI和多个淋巴结受累。
