局部进展期直肠癌新辅助化疗后病理完全缓解及肿瘤降期的预测因素分析

Predictive factors associated with pathologic complete response and tumor downstaging after neoadjuvant chemotherapy in locally advanced rectal cancer

目的:探索局部进展期直肠癌(LARC)经新辅助化疗后病理完全缓解(pCR)和肿瘤降期(ypT 0-1)的预测因素。方法:回顾性分析71例经新辅助化疗后进行全直肠系膜切除术的局部进展期直肠癌患者的临床资料,分析其临床特征,筛选经新辅助化疗后达到pCR及肿瘤降期(ypT 0-1)的预测因子。结果:单因素分析结果显示肿瘤占肠腔<1/2周(P<0.001)、基线CEA≤5 ng/mL(P=0.001)、基线临床N分期为N 0期(P=0.019)以及新辅助治疗2周期后影像评估为缓解(P=0.002)与直肠癌新辅助化疗后的高pCR率有关;肿瘤占肠腔<1/2周(P<0.001)、基线CEA≤5 ng/mL(P=0.029)以及新辅助治疗2周期后影像评估为缓解(P=0.007)与直肠癌新辅助化疗后的高肿瘤降期率(ypT 0-1)有关。多因素Logistic回归分析结果显示,肿瘤占肠腔环周大小(P=0.013)、基线CEA水平(P=0.042)以及基线临床N分期(P=0.038)是影响直肠癌新辅助化疗后pCR的独立预测因子;肿瘤占肠腔环周大小(P=0.001)是影响直肠癌新辅助化疗后肿瘤降期(ypT 0-1)的独立预测因子。结论:初始诊断时肿瘤占肠腔环周大小、基线CEA水平及淋巴结是否阳性对局部进展期直肠癌新辅助化疗后pCR有预测作用,肿瘤占肠腔环周大小对局部进展期直肠癌新辅助化疗后肿瘤降期(ypT 0-1)有预测作用。

Objective:To explore the predictive factors of pathologic complete response(pCR)and tumor downstaging(ypT 0-1)after neoadjuvant chemotherapy for locally advanced rectal cancer(LARC).Methods:71 patients with LARC who underwent total mesenterectomy after neoadjuvant chemotherapy were analyzed retrospectively.We analyzed the clinical characteristics of these LARC patients and screened the predictive factors associated with pCR and tumor downstaging(ypT 0-1)after neoadjuvant chemotherapy.Results:Single factor analysis showed that the tumor occupied<1/2 circle of the intestinal cavity(P<0.001),baseline CEA≤5 ng/mL(P=0.001),baseline N 0 stage(P=0.019),and imaging assessment of remission after 2 cycles of neoadjuvant therapy(P=0.002)were correlated with high pCR rate after neoadjuvant chemotherapy for rectal cancer.The tumor occupied<1/2 circle of the intestinal cavity(P<0.001),baseline CEA≤5 ng/mL(P=0.029),and imaging assessment of remission after 2 cycles of neoadjuvant therapy(P=0.007)were correlated with high tumor downstaging(ypT 0-1)rate after neoadjuvant chemotherapy for rectal cancer.Logistic regression analysis showed that tumor size(P=0.013),baseline CEA level(P=0.042)and baseline N stage(P=0.038)were independent predictors of pCR after neoadjuvant chemotherapy for rectal cancer.Tumor size(P=0.001)was an independent predictor of tumor downstaging(ypT 0-1)after neoadjuvant chemotherapy for rectal cancer.Conclusion:The size of tumor,the baseline CEA level and whether the lymph node was positive at initial diagnosis can predict pCR and the size of tumor at initial diagnosis can predict the tumor downstaging(ypT 0-1)after neoadjuvant chemotherapy for LARC.