赵稳, 李智, 杜记涛, 赵卫杰, 陈广龙, 曹建, 万相斌. 直肠腺癌新辅助放化疗疗效影响因素及病理完全缓解对预后的影响[J]. 中国肿瘤临床, 2021, 48(1): 8-13. DOI: 10.3969/j.issn.1000-8179.2021.01.913
引用本文: 赵稳, 李智, 杜记涛, 赵卫杰, 陈广龙, 曹建, 万相斌. 直肠腺癌新辅助放化疗疗效影响因素及病理完全缓解对预后的影响[J]. 中国肿瘤临床, 2021, 48(1): 8-13. DOI: 10.3969/j.issn.1000-8179.2021.01.913
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Wen Zhao, Zhi Li, Jitao Du, Weijie Zhao, Guanglong Chen, Jian Cao, Xiangbin Wan. Factors influencing the efficacy of neoadjuvant chemoradiotherapy on rectal adenocarcinoma and the effect of pathologic complete response on prognosis[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(1): 8-13. DOI: 10.3969/j.issn.1000-8179.2021.01.913
Citation: Wen Zhao, Zhi Li, Jitao Du, Weijie Zhao, Guanglong Chen, Jian Cao, Xiangbin Wan. Factors influencing the efficacy of neoadjuvant chemoradiotherapy on rectal adenocarcinoma and the effect of pathologic complete response on prognosis[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2021, 48(1): 8-13. DOI: 10.3969/j.issn.1000-8179.2021.01.913
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直肠腺癌新辅助放化疗疗效影响因素及病理完全缓解对预后的影响

Factors influencing the efficacy of neoadjuvant chemoradiotherapy on rectal adenocarcinoma and the effect of pathologic complete response on prognosis

    摘要
  • 摘要:
      目的  探讨直肠腺癌新辅助放化疗（neoadjuvant chemoradiotherapy，NCRT）后病理完全缓解（pathologic complete response，pCR）的影响因素及pCR对生存的影响。
      方法  回顾性分析2014年1月至2017年12月郑州大学附属肿瘤医院收治的98例直肠腺癌NCRT患者的临床病理资料，分析临床病理特征与pCR的关系以及pCR对预后的影响。
      结果  98例患者NCRT后19例（19.4%）获得pCR。单因素分析显示，术前淋巴结转移情况、治疗前CEA水平、肿瘤大小、肿瘤侵犯肠壁周径程度以及KRAS基因状态与直肠腺癌NCRT后pCR相关。Logistic回归多因素分析显示，治疗前CEA≤5 μg/L（OR=4.095，95%CI：1.131~14.823，P=0.032）和肿瘤侵犯肠壁周径（≤1/2）（OR=3.268，95%CI：1.015~10.527，P=0.047）是影响直肠腺癌NCRT后pCR的独立因素。生存分析显示非pCR患者的3年无病生存率（disease-free survival，DFS）为71.1%，显著低于pCR患者100%（P < 0.05）；两者3年总生存率（overall survival，OS）分别为100%和88.5%，差异无统计学意义（P>0.05）。
      结论  治疗前检测CEA以及评估肿瘤侵犯肠壁周径程度有助于预测直肠腺癌NCRT后pCR率，提示两者可作为新辅助放化疗疗效的评价指标，并指导临床进行个体化治疗。与pCR患者相比，非pCR直肠癌患者DFS较短。

     

    Abstract:
      Objective   To investigate the factors influencing the achievement of pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) for rectal adenocarcinoma and to investigate the effect of pCR on survival outcome.
      Methods   A total of 98 patients with rectal adenocarcinoma who underwent NCRT combined with curative resection between January 2014 and December 2017 at The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital were retrospectively enrolled. The correlations of clinicopathological features with pCR were evaluated, and the influence of pCR on prognosis was analyzed.
      Results  :Of the 98 patients, 19 (19.4%) achieved pCR after NCRT. Univariate analysis showed that preoperative lymph node status, pre-chemoradiotherapy carcinoembryonic antigen (CEA) levels, tumor size, invasion of the circumference of intestinal wall, and KRAS mutation status were significant influencing factors. Logistic regression revealed that pre-chemoradiotherapy CEA levels (≤5 μg/L) odds ratio (OR)=4.095, 95% confidence interval (CI): 1.131-14.823, P=0.032 and invasion of the circumference of intestinal wall (≤1/2) (OR=3.268, 95% CI: 1.015-10.527, P=0.047) were independent factors influencing the achievement of pCR after NCRT for rectal cancer. Univariate survival analysis showed that the 3-year disease-free survival (DFS) rate in the non-pCR group was 71.1%, which was significantly lower than that in the pCR group (100.0%, P < 0.05). There was no significant difference in the 3- year overall survival rate between the pCR (100.0%) and non-pCR (88.5%) groups (P>0.05).
      Conclusions   Pre-treatment CEA levels and invasion of the circumference of intestinal wall are helpful in predicting the achievement of pCR. It is suggested that both can be used as indicators for evaluating tumor response after radical resection and neoadjuvant therapy. Therefore, the evaluation of these factors will be helpful in guiding individualized treatment. The DFS rate in the non-pCR group was worse than that in the pCR group.

     

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