Predictors of Complete Response and Disease Recurrence Following Chemoradiation for Rectal Cancer.
Predictors of Complete Response and Disease Recurrence Following Chemoradiation for Rectal Cancer.
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直肠癌化学放疗后完全反应和疾病复发的预测指标。
DOI：
10.3389/fonc.2015.00286
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发表时间：
2015
影响因子：
4.7
通讯作者：
Du KL
中科院分区：
文献类型：
--
作者：
Bitterman DS;Resende Salgado L;Moore HG;Sanfilippo NJ;Gu P;Hatzaras I;Du KL
大约 10-40% 的直肠患者对新辅助放化疗 (CRT) 具有完全缓解 (CR)，并且这些患者的生存率得到改善。因此，非手术治疗（“观察等待”方法）可能是特定患者的一种选择。我们的目的是确定 CRT 后 CR 的临床预测因素。对 2004 年 8 月至 2015 年 2 月接受明确 CRT 治疗的 T3-T4、局部不可切除的 T1-T2、低位 T2 和/或淋巴结阳性直肠癌患者进行回顾性分析。大多数患者接受 50.4Gy 放射治疗并同时使用 5-氟尿嘧啶或卡培他滨。如果手术病理学显示 ypT0N0M0（手术治疗），或者临床和放射学评估中没有残留疾病的证据（非手术治疗），则认为患者获得 CR。进行统计分析以确定 CR 和长期结果的预测因子。有 138 名患者的完整记录。中位随访时间为 24.5 个月。 36 名患者 (26.3%) 达到 CR； 30/123 例接受手术治疗的患者 (24.5%) 和 6/15 (40%) 未接受手术治疗的患者。 10 名粘液腺癌患者中无一人达到 CR。诊断时癌胚抗原（CEA）≥5 μg/L（OR 0.190，95% CI 0.037–0.971，p = 0.046），肿瘤大小≥3 cm（OR 0.123，95% CI 0.020–0.745，p = 0.023），距离肿瘤距肛缘≥3 cm（OR 0.091，95% CI 0.013–0.613，p = 0.014），诊断时临床淋巴结阳性（OR 0.201，95% CI 0.045–0.895，p = 0.035），从 CRT 到手术的间隔≥8 周（OR 5.267，95% CI 1.068–25.961，p = 0.041）是 CR 的独立预测因子。 CR 组的 3 年无远处转移生存率 (DMFS)（93.7 vs. 63.7%，p = 0.016）和 3 年无病生存率 (DFS)（91.1 vs. 67.8%，p = 0.038）更长。 CR 组的三年局部控制 (LRC)（96.6 vs. 81.3%，p = 0.103）和总生存率（97.2 vs. 87.5%，p = 0.125）较高，但这并未达到统计学显着性。 CR 不是 LRC、DMFS 或 DFS 的独立预测因子。诊断时的 CEA、肿瘤大小、肿瘤距肛缘的距离、诊断时的淋巴结阳性以及从 CRT 到手术的时间间隔是 CR 的预测因素。这些临床变量可以让我们深入了解观察等待方法中的患者选择和治疗反应评估的时机。
Approximately 10–40% of rectal patients have a complete response (CR) to neoadjuvant chemoradiation (CRT), and these patients have improved survival. Thus, non-operative management (“watch-and-wait” approach) may be an option for select patients. We aimed to identify clinical predictors of CR following CRT. Patients treated with definitive CRT for T3–T4, locally unresectable T1–T2, low-lying T2, and/or node-positive rectal cancer from August 2004 to February 2015 were retrospectively reviewed. Most patients were treated with 50.4 Gy radiation and concurrent 5-fluoruracil or capecitabine. Patients were considered to have a CR if surgical pathology revealed ypT0N0M0 (operative management), or if they had no evidence of residual disease on clinical and radiographic assessment (non-operative management). Statistical analysis was carried out to determine predictors of CR and long-term outcomes. Complete records were available on 138 patients. The median follow-up was 24.5 months. Thirty-six patients (26.3%) achieved a CR; 30/123 operatively managed patients (24.5%) and 6/15 (40%) non-operatively managed patients. None of the 10 patients with mucinous adenocarcinoma achieved a CR. Carcinoembryonic antigen (CEA) ≥5 μg/L at diagnosis (OR 0.190, 95% CI 0.037–0.971, p = 0.046), tumor size ≥3 cm (OR 0.123, 95% CI 0.020–0.745, p = 0.023), distance of tumor from the anal verge ≥3 cm (OR 0.091, 95% CI 0.013–0.613, p = 0.014), clinically node-positive disease at diagnosis (OR 0.201, 95% CI 0.045–0.895, p = 0.035), and interval from CRT to surgery ≥8 weeks (OR 5.267, 95% CI 1.068–25.961, p = 0.041) were independent predictors of CR. The CR group had longer 3-year distant metastasis-free survival (DMFS) (93.7 vs. 63.7%, p = 0.016) and 3-year disease-free survival (DFS) (91.1 vs. 67.8%, p = 0.038). Three-year locoregional control (LRC) (96.6 vs. 81.3%, p = 0.103) and overall survival (97.2 vs. 87.5%, p = 0.125) were higher in the CR group but this did not achieve statistical significance. CR was not an independent predictor of LRC, DMFS, or DFS. CEA at diagnosis, tumor size, tumor distance from the anal verge, node positivity at diagnosis, and interval from CRT to surgery were predictors of CR. These clinical variables may offer insight into patient selection and timing of treatment response evaluation in the watch-and-wait approach.