Chen Siyuan, Wu Ruiyan, Wan Juefeng, Xu Yun, Wang Yaqi, Zhang Zhiyuan, Huang Lili, Liu Yujun, Lin Yingxuan, He Luoxi, Deng Yun, Xia Fan, Xu Ye, Zhang Zhen, Zheng Hongtu
Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Cancer Med. 2025 Aug;14(15):e71042. doi: 10.1002/cam4.71042.
To compare the long-term survival of patients with locally advanced low rectal cancer (LALRC), receiving neoadjuvant chemoradiotherapy (NCRT) versus adjuvant chemoradiotherapy (ACRT).
This retrospective observational study included 1169 patients with LALRC (Stage II/III disease located ≤ 5 cm from the anal verge) who underwent diagnosis and treatment at Fudan University Shanghai Cancer Center from February 2006 to March 2021. In Stage II/III low rectal cancer patients, one-to-one matched pairs were created from the ACRT and NCRT groups using propensity score matching (PSM) based on baseline characteristics. OS and DFS were evaluated using the Kaplan-Meier method alongside the univariate Cox regression model.
In Stage II patients, 65 received ACRT and 107 received NCRT. For Stage III, 282 received ACRT and 715 received NCRT. After PSM, 45 paired Stage II patients and 243 paired Stage III patients were selected. In Stage II patients, there was no significant difference in OS and DFS between the groups. For Stage III, the 5- and 10-year OS rates were 79.61% and 77.67% in the NCRT group, compared to 61.08% and 44.57% in the ACRT group (p < 0.001). The 5- and 10-year DFS rates were 69.93% and 65.26% in the NCRT group, versus 48.07% and 40.77% in the ACRT group (p < 0.001). Additionally, in Stage III patients, NCRT was associated with a significant reduction in the risk of death and recurrence compared to ACRT (OS: HR = 0.47, p = 0.0001; DFS: HR = 0.55, p = 0.0001).
For patients with Stage III low rectal cancer, NCRT significantly improved the long-term DFS rate and OS rate, in comparison to adjuvant chemoradiotherapy.
比较接受新辅助放化疗（NCRT）与辅助放化疗（ACRT）的局部晚期低位直肠癌（LALRC）患者的长期生存率。
这项回顾性观察性研究纳入了2006年2月至2021年3月在复旦大学附属上海肿瘤医院接受诊断和治疗的1169例LALRC患者（疾病分期为II/III期，距肛缘≤5 cm）。在II/III期低位直肠癌患者中，根据基线特征，使用倾向评分匹配（PSM）从ACRT组和NCRT组中创建一对一匹配对。使用Kaplan-Meier方法和单变量Cox回归模型评估总生存期（OS）和无病生存期（DFS）。
在II期患者中，65例接受ACRT，107例接受NCRT。在III期患者中，282例接受ACRT，715例接受NCRT。PSM后，选择了45对II期配对患者和243对III期配对患者。在II期患者中，两组之间的OS和DFS无显著差异。对于III期患者，NCRT组的5年和10年总生存率分别为79.61%和77.67%，而ACRT组分别为61.08%和44.57%（p<0.001）。NCRT组的5年和10年无病生存率分别为69.93%和65.26%，而ACRT组分别为48.07%和40.77%（p<0.001）。此外，在III期患者中，与ACRT相比，NCRT与死亡和复发风险的显著降低相关（OS：风险比[HR]=0.47，p=0.0001；DFS：HR=0.55，p=0.0001）。
对于III期低位直肠癌患者，与辅助放化疗相比，新辅助放化疗显著提高了长期无病生存率和总生存率。
