Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
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DOI：
10.1111/codi.14361
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发表时间：
2018-09-01
影响因子：
3.4
通讯作者：
Frasson, Matteo
中科院分区：
文献类型：
--
作者：
Battersby, Nick;Glasbey, James C.;Frasson, Matteo
局部进展期直肠癌的主要治疗方法是手术切除后的放化疗。在放化疗后，可以在手术前或手术后病理学上（pCR）在临床和放射学上（cCR）检测到完全缓解。我们的目的是报告的整体完全病理反应（pCR）率和检测cCR的可靠性，通过传统的术前imaging.MethodsA预先计划的分析，欧洲结肠直肠学会（ESCP）2017年审计进行。纳入了接受择期直肠切除术治疗的患者。pCR定义为ypT 0 N 0 EMVI阴性原发性肿瘤;部分缓解表示放化疗后相对于基线分期的任何消退。主要终点为pCR率。次要终点是治疗后的MRI restaging（yMRI）和最终的病理staging.ResultsOf 2572例患者接受直肠癌手术在277个参与中心在44个国家，673（26.2%）进行了放化疗和手术之间的协议。pCR率为10.3%（67/649），部分缓解率为35.9%（233/649）。通过治疗后yMRI确定的AJCC分期与最终病理学的比较显示，13%（55/429）的分期过低，34%（148/429）的分期过高。对于T分期、N分期或AJCC状态，yMRI和最终病理学之间的一致性均被分级为“仅公平”（n=429，Kappa分别为0.25、0.26和0.35）。在对照临床试验的背景下，基本常规放化疗后成像评估技术与病理学之间的一致性强度有限，这表明应考虑替代反应标志物。
IntroductionThe mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging.MethodsA pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging.ResultsOf 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as fair' only (n=429, Kappa 0.25, 0.26 and 0.35 respectively).ConclusionThe reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials.