Pathologic Complete Response After Neoadjuvant Treatment for Rectal Cancer Decreases Distant Recurrence and Could Eradicate Local Recurrence
Pathologic Complete Response After Neoadjuvant Treatment for Rectal Cancer Decreases Distant Recurrence and Could Eradicate Local Recurrence
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DOI：
10.1245/s10434-010-1506-1
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发表时间：
2011-06-01
影响因子：
3.7
通讯作者：
Kalady, Matthew F.
中科院分区：
文献类型：
--
作者：
de Campos-Lobato, Luiz Felipe;Stocchi, Luca;Kalady, Matthew F.
本研究的目的是评估病理完全缓解（pCR）（即，T0 N 0 M0）。在1997年至2007年期间，对经CT和ERUS/MRI分期的原发性cII和cIII直肠癌患者进行前瞻性维护的单中心结直肠癌数据库查询，这些患者接受了长期新辅助放化疗，随后进行了根治性直肠切除术。将患者分为pCR组和非pCR组，并在人口统计学、肿瘤和治疗特征以及肿瘤学结局方面进行比较。结果评价为5年总生存率、无病生存率、疾病特异性死亡率、局部复发率和远处复发率。查询返回238例患者（73%为男性），中位年龄为57岁，中位随访时间为54个月。其中，58例患者实现了pCR。pCR患者与无pCR患者在人口统计学、放化疗方案、肿瘤距肛缘的距离、临床分期、手术操作和随访时间方面具有统计学可比性。pCR患者无局部复发。对于达到pCR的患者，总生存率和远处复发也显著改善。新辅助放化疗后达到pCR与局部晚期直肠癌预后的显著改善相关。未来的研究应评估pCR率增加与该人群癌症结局改善之间的关系。
The aim of this study was to evaluate the clinical implications of pathologic complete response (pCR) (i.e., T0N0M0) after neoadjuvant chemoradiation and radical surgery in patients with locally advanced rectal cancer.A single-center, prospectively maintained colorectal cancer database was queried for patients with primary cII and cIII rectal cancer staged by CT and ERUS/MRI undergoing long-course neoadjuvant chemoradiation followed by proctectomy with curative intent between 1997 and 2007. Patients were stratified into pCR and no-pCR groups and compared with respect to demographics, tumor and treatment characteristics, and oncologic outcomes. Outcomes evaluated were 5-year overall survival, disease-free survival, disease-specific mortality, local recurrence, and distant recurrence.The query returned 238 patients (73% male), with a median age of 57 years and median follow-up of 54 months. Of these, 58 patients achieved pCR. Patients with pCR vs no-pCR were statistically comparable with respect to demographics, chemoradiation regimens, tumor distance from anal verge, clinical stage, surgical procedures performed, and follow-up time. No patient with pCR had local recurrence. Overall survival and distant recurrence were also significantly improved for patients achieving pCR.Achievement of pCR after neoadjuvant chemoradiation is associated with greatly improved cancer outcomes in locally advanced rectal cancer. Future studies should evaluate the relationship between increases in pCR rates and improvements in cancer outcomes in this population.