Predictors and Risk Factors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Population-Based Analysis
Predictors and Risk Factors of Pathologic Complete Response Following Neoadjuvant Chemoradiotherapy for Rectal Cancer: A Population-Based Analysis
复制标题
直肠癌新辅助放化疗后病理完全缓解的预测因子和危险因素：基于人群的分析
DOI：
10.3389/fonc.2019.00497
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发表时间：
2019-06-13
影响因子：
4.7
通讯作者：
Ding, Kefeng
中科院分区：
文献类型：
--
作者：
Tan, Yinuo;Fu, Dongliang;Ding, Kefeng
背景：直肠癌患者在新辅助放化疗（nCRT）后达到病理完全缓解（pCR）可能有更好的预后，可能有资格进行非手术治疗。本研究的目的是确定预测直肠癌患者nCRT后pCR的变量，并确定直肠癌患者pCR至nCRT和根治性切除后预后不良的临床危险因素。方法：对2004 - 2013年监测、流行病学和最终结果（SEER）数据库进行回顾性分析。本研究纳入了新辅助放化疗后接受根治性切除的非转移性直肠癌患者。对临床病理特征与pCR之间的关系进行多因素分析，并使用逻辑回归模型确定pCR的独立预测因子。采用决策曲线分析，建立多变量logistic回归的nomogram来评估临床有效性。结果：本研究共纳入6555例患者。pCR患者比例为20.5% （n = 1342）。基于多因素logistic回归分析的nomogram显示，临床T4和N2分期是未实现pCR的最显著独立临床预测因子，其次是粘液腺癌和治疗前血清CEA阳性。pCR组3年总生存率为92.4%，未pCR组为88.2%。在所有pCR患者中，粘液腺癌患者的生存率最差，3年总生存率为67.5%，而普通腺癌患者的总生存率为93.8% （P < 0.001）。单因素和多因素分析显示组织学和临床N2分期是独立的危险因素。结论：黏液性腺癌、治疗前血清CEA阳性、临床T4和N2分期可能给患者实现pCR带来困难。黏液腺癌和临床N2期可能预示着预后不利的生物肿瘤特征，更倾向于局部或远处复发，生存率降低。
Background: Patients with rectal cancer who achieve pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) may have a better prognosis and may be eligible for non-operative management. The aim of this research was to identify variables for predicting pCR in rectal cancer patients after nCRT and to define clinical risk factors for poor outcome after pCR to nCRT and radical resection in rectal cancer patients. Methods: A retrospective review was performed using the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Non-metastatic rectal cancer patients who received radical resection after neoadjuvant chemoradiotherapy were included in this study. Multivariate analysis of the association between clinicopathological characteristics and pCR was performed, and a logistic regression model was used to identify independent predictors for pCR. A nomogram based on the multivariate logistics regression was built with decision curve analyses to evaluate the clinical usefulness. Results: A total of 6,555 patients were included in this study. The proportion of patients with pCR was 20.5% (n = 1,342). The nomogram based on multivariate logistic regression analysis showed that clinical T4 and N2 stages were the most significant independent clinical predictors for not achieving pCR, followed by mucinous adenocarcinoma and positive pre-treatment serum CEA results. The 3-year overall survival rate was 92.4% for those with pCR and 88.2% for those without pCR. Among all the pCR patients, mucinous adenocarcinoma patients had the worst survival, with a 3-year overall survival rate of 67.5%, whereas patients with common adenocarcinoma had an overall survival rate of 93.8% (P < 0.001). Univariate and multivariate analyses showed that histology and clinical N2 stage were independent risk factors. Conclusion: Mucinous adenocarcinoma, positive pre-treatment serum CEA results, and clinical T4 and N2 stages may impart difficulty for patients to achieve pCR. Mucinous adenocarcinoma and clinical N2 stage might be indicative of a prognostically unfavorable biological tumor profile with a greater propensity for local or distant recurrence and decreased survival.