Zhou Jianxi, Sun Yunchuan, Xiao Li, Lu Hongling, Yin Xiaoming, Kong Yaru, Zhang Yiyan, Guo Wei, Zhou Yingnan
Department of Radiation Oncology, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine-Hebei Province, Cangzhou, Hebei 061000, P.R. China.
Department of Radiotherapy and Chemotherapy, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine East Ward, Cangzhou, Hebei 061000, P.R. China.
Oncol Lett. 2025 May 22;30(1):359. doi: 10.3892/ol.2025.15105. eCollection 2025 Jul.
Neoadjuvant chemoradiotherapy (nCRT) has been shown to improve outcomes for patients with rectal cancer, but the impact of the lymph node status after achieving pathological complete response remains elusive. The present study aimed to assess the prognosis and influencing factors of patients with rectal cancer with different lymph node statuses after achieving a pathological complete response to nCRT. The clinical data of 203 patients enrolled from Hengshui People's Hospital and Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine from January 2010 to December 2020 were retrospectively analyzed. These patients had undergone preoperative nCRT and were pathologically classified as 'tumor stage 0 and lymph node status 0 after neoadjuvant therapy' (ypT0N0) or 'tumor stage 0 and residual tumor in regional lymph nodes after neoadjuvant therapy' (ypT0N+) postoperatively. After surgery, patients were followed up to evaluate tumor recurrence, metastasis and survival, including disease-free survival (DFS) and overall survival (OS). Cox proportional hazards models were used to analyze factors affecting DFS and OS. Among the 203 patients included, there were 127 cases in the ypT0N0 group and 76 cases in the ypT0N+ group. The median follow-up time for the entire cohort was 56 months (range, 13-107 months). Furthermore, 72 patients (35.5%) experienced recurrence, including 53 cases (26.1%) of distant metastasis, 10 cases (4.9%) of local recurrence and 9 cases (4.4%) of both distant metastasis and local recurrence. The 5-year OS and DFS rates for all patients were 82.3 and 77.3%, respectively. The 5-year OS rates for the ypT0N0 and ypT0N+ groups were 96.1 and 59.2% (P<0.0001), respectively, and the 5-year DFS rates were 88.2 and 59.2% (P=0.0002), respectively. In addition, clinical tumor stage (cT)3-4, clinical lymph node stage (cN)+, elevated serum carcinoembryonic antigen (CEA) and postoperative pathology (ypT0N+) were independent risk factors affecting OS and DFS. In summary, the results of the present study indicate that patients with ypT0N0 rectal cancer can achieve a good long-term prognosis after nCRT. Notably, postoperative treatment and follow-up should be performed for patients with ypT0N+ and those with elevated pre-nCRT CEA, cT3-4 and cN+ stages.
新辅助放化疗（nCRT）已被证明可改善直肠癌患者的预后，但达到病理完全缓解后淋巴结状态的影响仍不明确。本研究旨在评估直肠癌患者在nCRT达到病理完全缓解后不同淋巴结状态的预后及影响因素。回顾性分析了2010年1月至2020年12月期间从衡水市人民医院和河北沧州中西医结合医院纳入的203例患者的临床资料。这些患者均接受了术前nCRT，术后病理分类为“新辅助治疗后肿瘤分期0且淋巴结状态0”（ypT0N0）或“新辅助治疗后肿瘤分期0且区域淋巴结有残留肿瘤”（ypT0N+）。手术后，对患者进行随访以评估肿瘤复发、转移和生存情况，包括无病生存期（DFS）和总生存期（OS）。采用Cox比例风险模型分析影响DFS和OS的因素。纳入的203例患者中，ypT0N0组127例，ypT0N+组76例。整个队列的中位随访时间为56个月（范围13 - 107个月）。此外，72例患者（35.5%）出现复发，其中远处转移53例（26.1%），局部复发10例（4.9%），远处转移合并局部复发9例（4.4%）。所有患者的5年总生存率和无病生存率分别为82.3%和77.3%。ypT0N0组和ypT0N+组的5年总生存率分别为96.1%和59.2%（P<0.0001），5年无病生存率分别为88.2%和59.2%（P = 0.0002）。此外，临床肿瘤分期（cT）3 - 4、临床淋巴结分期（cN）+、血清癌胚抗原（CEA）升高及术后病理（ypT0N+）是影响OS和DFS的独立危险因素。总之，本研究结果表明，ypT0N0直肠癌患者在nCRT后可获得良好的长期预后。值得注意的是，对于ypT0N+以及nCRT前CEA升高、cT3 - 4和cN+分期的患者，应进行术后治疗和随访。
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