Clinical Prediction of Pathological Complete Response After Preoperative Chemoradiotherapy for Rectal Cancer
Clinical Prediction of Pathological Complete Response After Preoperative Chemoradiotherapy for Rectal Cancer
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DOI：
10.1097/dcr.0b013e3182837e5b
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发表时间：
2013-06-01
影响因子：
3.9
通讯作者：
Kim, Young Jin
中科院分区：
文献类型：
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作者：
Huh, Jung Wook;Kim, Hyeong Rok;Kim, Young Jin
背景：目前尚不清楚准确预测直肠癌放化疗反应的临床预处理因素。目的：本研究的目的是评估直肠癌术前放化疗后病理完全缓解的相关临床因素。设计：本研究对前瞻性收集的数据进行回顾性分析。背景：本研究在韩国一家三级保健医院/转诊中心进行。患者：自2000年12月至2011年9月，共发现391例连续接受新辅助放化疗后根治性手术的直肠癌患者。治疗包括同步放化疗，包括术前5-氟尿嘧啶化疗和盆腔放疗（中位数，5040 cGy）；8周后（中位，57天）进行手术治疗。主要结局指标：主要结局指标为病理完全缓解组（n = 57, 14.6%）和非病理完全缓解组（n = 334, 85.4%）的临床病理比较。结果：病理完全缓解组非周周肿瘤、非肉眼溃疡、分化良好、肿瘤直径小、临床早期T期、临床早期N期或低水平预处理CEA的比例高于非病理完全缓解组。在多因素回归分析中，较高病理完全缓解率的独立预测因子为非周期性（p = 0.007； OR, 3.214）、非肉眼溃疡（p = 0.002； OR, 6.702）和低预处理CEA水平（p = 0.004； OR, 2.656）。4个危险分层组病理完全缓解率差异有统计学意义（p < 0.001）。临床风险评分模型预测病理完全缓解的敏感性为64.1%，特异性为73.7%（曲线下面积0.706,p < 0.001）。局限性：本研究的局限性在于它是一个单机构的小样本量研究。结论：预处理临床变量，包括肿瘤周长、宏观溃疡和CEA水平，可能是实现病理完全缓解的重要决定因素。
BACKGROUND: The clinical pretreatment factors that accurately predict response to chemoradiation in rectal cancer are not currently known.OBJECTIVE: The aim of this study is to evaluate the clinical factors associated with a pathological complete response after preoperative chemoradiotherapy for rectal cancer.DESIGN: This study is a retrospective review of prospectively collected data.SETTING: This study was conducted at a tertiary care hospital/referral center in South Korea.PATIENTS: From December 2000 to September 2011, a total of 391 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by radical surgery were identified. The treatment consisted of concurrent chemoradiation, which included preoperative 5-fluorouracil-based chemotherapy and pelvic radiation (median, 5040 cGy); this was followed 8 weeks later (median, 57 days) by surgery with curative intent.MAIN OUTCOME MEASURES: The primary outcome measured was the clinicopathological comparison between pathological complete response (n = 57, 14.6%) and non-pathological complete response (n = 334, 85.4%) groups.RESULTS: The pathological complete response groups had a higher percentage of noncircumferential tumors, nonmacroscopic ulceration, well differentiation, small tumor diameter, early clinical T stage, early clinical N stage, or low levels of pretreatment CEA than the non-pathological complete response group. In multivariate regression analysis, independent predictors of a higher pathological complete response rate were noncircumferentiality (p = 0.007; OR, 3.214), nonmacroscopic ulceration (p = 0.002; OR, 6.702), and low pretreatment CEA level (p = 0.004; OR, 2.656). Significant differences in the pathological complete response rate existed among the 4 risk stratification groups (p < 0.001). For the prediction of pathological complete response by the clinical risk score model, the sensitivity was 64.1% and the specificity was 73.7% (area under the curve, 0.706; p < 0.001).LIMITATIONS: This study was limited because it was a single-institution study with a small sample size.CONCLUSIONS: Pretreatment clinical variables, including tumor circumferentiality, macroscopic ulceration, and CEA level, may be important determinants in achieving a pathological complete response.