多周期新辅助化疗联合阿帕替尼对进展期直肠癌的疗效评价:基于DACCA数据库的辅助研究

Efficacy of multicycle neoadjuvant chemotherapy combined with apatinib in treatment of advanced rectal cancer: a supportive study of Database from Colorectal Cancer

目的通过研究华西肠癌数据库(Database from Colorectal Cancer,DACCA),讨论多周期新辅助化疗联合阿帕替尼对进展期直肠癌的疗效。方法数据库选择DACCA2019年1月20日版本,提取接受2~4个周期新辅助化疗联合阿帕替尼方案后行手术的173例进展期直肠癌患者的临床资料,按治疗周期和cTNM分期分组,比较患者治疗前后、不同治疗周期和不同cTNM分期患者的疗效。结果173例患者中,接受2个周期治疗63例(36.42%),3个周期45(26.01%)例,4个周期65例(37.57%);cTNM分期:Ⅱ期54例(31.21%),Ⅲ期91例(52.60%),Ⅳ期28例(16.18%)。173例患者治疗后的CEA水平较治疗前降低(P<0.001)。临床缓解程度:完全缓解(CR)58例(33.53%),部分缓解(PR)93例(53.76%),疾病稳定(SD)21例(12.14%),疾病进展(PD)1例(0.58%),达到病理完全缓解(cPR)者共23例(13.29%);肿瘤缓解等级(TRG)分级:TRG021例(12.57%),TRG122例(13.17%),TRG284例(50.30%),TRG340例(23.95%)。所有患者均成功行根治性切除,转化切除成功率为100%。不同治疗周期患者的临床缓解程度不同(H=18.513,P<0.001),更长的用药周期与更优的临床缓解程度具有相关性(G=–0.474,P<0.001)。不同cTNM分期患者的cPR率比较差异有统计学意义(χ^2=6.450,P=0.040)。结论进展期直肠癌患者应用多周期新辅助化疗联合阿帕替尼时,治疗周期越多,临床效果更好;治疗前分期越早,cPR率更高;多周期新辅助化疗联合阿帕替尼的手术转化切除率满意。

Objective To evaluate the efficacy of multicycle neoadjuvant chemotherapy combined with apatinib in the treatment of advanced rectal cancer through the Database from Colorectal Cancer (DACCA). Methods A total of 173 patients with advanced rectal cancer who underwent surgery after 2–4 cycles of neoadjuvant chemotherapy combined with apatinib were selected from the DACCA (Version January 20, 2019). The patients were grouped by treated cycle and clinical TNM (cTNM) stage, and the overall variation of clinical and pathological indicators before and after treatment were compared. Results Among 173 cases, 63 cases (36.42%), 45 cases (26.01%), and 65 cases (37.57%) were respectively in the 2, 3, and 4-cycle group;54 cases (31.21%), 91 cases (52.60%), and 28 cases (16.18%) in stage Ⅱ,Ⅲ, and Ⅳ-group. Clinical response degree: complete pathologic response (cPR) was observed in 23 cases (13.29%), and the rate of conversion resection was 100%(173/173). Clinical response grade: complete response (CR) in 58 cases (33.53%), partial response (PR) in 93 cases (53.76%), stable disease (SD) in 21 cases (12.14%), progressive disease (PD) in 1 cases (0.58%). Tumor regression grade: TRG0 in 21 cases (12.57%), TRG1 in 22 cases (13.17%), TRG2 in 84 cases (50.30%), TRG3 in 40 cases (23.95%). There was a statistical difference in CEA before and after the treatment (P<0.001). All cases underwent radical resection, and the successful rate of transformed resection was 100%. There was significant difference on the clinical response grade among the cases of different treatment cycle (H=18.513, P<0.001), and the longer treatment cycle was correlated with better clinical response (G=–0.474, P<0.001). In addition, there was significant difference on the cPR rate among the cases of different cTNM stage (χ^2 =6.450, P=0.040). Conclusions Multicycle neoadjuvant chemotherapy combined with apatinib in treating patients with advanced rectal cancer is efficient. More treatment cycles lead to better efficacy. The lower cTNM stage maybe means more chance of achieving cPR and a satisfactory rate of conversion resection.