Survival outcomes analysis according to mismatch repair status in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy.
Survival outcomes analysis according to mismatch repair status in locally advanced rectal cancer patients treated with neoadjuvant chemoradiotherapy.
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DOI：
10.3389/fonc.2022.920916
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发表时间：
2022
影响因子：
4.7
通讯作者：
Fu, Chuangang
中科院分区：
文献类型：
--
作者：
Chen, Lin;Yang, Xudong;Zhang, Yuanyuan;Liu, Jie;Jiang, Qixin;Ji, Fang;Gao, Jinli;Zhou, Zhuqing;Wang, Hao;Huang, Jun;Fu, Chuangang
关键词：
错配修复（MMR）状态对局部进展期直肠癌（LARC）患者新辅助放化疗环境中生存结局和敏感性的预测作用尚不确定。招募了接受新辅助放化疗（nCRT）治疗的LARC患者的回顾性队列。在调整基线特征后，我们使用倾向评分匹配来减少潜在混杂因素对MMR状态的影响。主要分析基于总生存期作为更重要的终点。本研究纳入了269例患者。与熟练MMR（pMMR）患者相比，缺陷MMR（dMMR）患者更年轻（58.5% vs. 60.0%，p=0.0274），体重指数更低（p =0.0091），分化程度更高（p=0.0889），直肠癌（临床T4或T4 b，p=0.0851; M1，p=0.0055）更晚期。然而，即使在M1亚组中，倾向评分匹配的dMMR患者（p=0.0013）也显示出上级总生存期。更重要的是，熟练的MMR患者如果经历早期病理降级，特别是淋巴结病理降级，可以达到与dMMR患者相似的预后。本回顾性研究的临床意义主要包括两点：（1）我们研究的数据证实，具有dMMR状态的LARC患者在nCRT后的总生存率更高，即使在M1亚组中也是如此。(2)在早期淋巴结病理分期降低的老年和女性患者中观察到相似的生存结局，无论是dMMR还是pMMR。
The predictive role of mismatch repair (MMR) status for survival outcomes and sensitivity in neoadjuvant chemoradiotherapy settings for patients with locally advanced rectal cancer (LARC) has been inconclusive. A retrospective cohort of patients with LARC treated with neoadjuvant chemoradiotherapy (nCRT) was recruited. After adjusting for baseline characteristics, we used propensity score matching to reduce the effect of potential confounding factors on MMR status. The primary analysis was based on overall survival as the more important endpoint. This study included 269 patients. Patients with defective MMR (dMMR) were younger (58.5% vs. 60.0%, p=0.0274) and had lower body mass indices (p=0.0091), higher differentiation grades (p=0.0889), and more advanced rectal cancers (clinical T4 or T4b, p=0.0851; M1, p=0.0055) than those with proficient MMR (pMMR). However, propensity score-matched patients with dMMR (p=0.0013) exhibited superior overall survival, even in the M1 subgroup. More importantly, patients with proficient MMR who undergo early pathological downstaging, especially lymph node pathological downstaging, can achieve a prognosis similar to that of patients with dMMR. The clinical significance of this retrospective study mainly includes two points: (1) Data from our study confirmed that LARC patients with dMMR status had better overall survival rates after nCRT, even in the M1 subgroup. (2) Similar survival outcomes were observed in older and female patients with early lymph node pathological downstaging, regardless of dMMR or pMMR.
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DOI：
10.1056/nejmoa2201445
发表时间：
2022-06-23
期刊：
The New England journal of medicine
影响因子：
--
作者：
通讯作者：
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影响因子：
8.4
作者：
Eisenhauer, E. A.;Therasse, P.;Verweij, J.
通讯作者：
Verweij, J.
影响因子：
158.5
作者：
Sauer, R;Becker, H;Raab, R
通讯作者：
Raab, R
影响因子：
--
作者：
Li, Jun;Liu, Hao;Lv, Bo
通讯作者：
Lv, Bo
DOI：
10.23750/abm.v89i9-s.7960
发表时间：
2018-12-17
期刊：
Acta bio-medica : Atenei Parmensis
影响因子：
--
作者：
De' Angelis, Gian Luigi;Bottarelli, Lorena;Negri, Francesca
通讯作者：
Negri, Francesca