直肠癌新辅助放化疗后病理完全缓解相关因素分析及评分系统构建

Factors associated with pathological complete response and construction of scoring system in patients with rectal cancer after neoadjuvant chemoradiotherapy

目的:探讨局部进展期中低位直肠癌新辅助放化疗(nCRT)后病理完全缓解(pCR)的相关因素并建立评分系统。方法:回顾性分析2016年1月至2020年1月华中科技大学同济医学院附属协和医院收治的159例行nCRT联合手术治疗的局部进展期中低位直肠癌患者的临床资料。结果:本组159例患者中33例(20.8%)患者达到pCR。单因素分析结果显示,nCRT前肿瘤最大厚度≤25 mm(P=0.046)、同步强化化疗(P=0.013)、nCRT前中性粒细胞/淋巴细胞比值(NLR)≤1.65(P=0.004)及nCRT前血清CEA≤5 ng/ml(P=0.016)均与pCR有关;多因素分析结果显示,同步强化化疗、nCRT前NLR及nCRT前血清CEA是pCR的独立相关因素。基于多因素分析结果构建pCR预测评分系统,评分为0、1、2、3分患者pCR的概率分别为42%(10/24)、30%(19/63)、5%(3/57)、7%(1/15)。评分≤1分患者pCR的概率为33%(29/87),评分?1分患者pCR的概率为6%(4/72),差异具有统计学意义(P?0.001)。评分系统的曲线下面积为0.729(95%CI:0.638~0.820,P?0.001)。结论:同步强化化疗、nCRT前NLR≤1.65及nCRT前血清CEA≤5 ng/ml是局部进展期中低位直肠癌pCR的独立预测因素,联合以上指标构建的评分系统可有效预测pCR。

Objective To identify the clinical factors associated with pathological complete response(pCR)after neoadjuvant chemoradiotherapy(nCRT)in locally advanced middle and low rectal cancer and establish a scoring system.Methods In this retrospective analysis the clinical data of patients with locally advanced middle and low rectal cancer treated with nCRT combined with surgery at Union Hospital of Tongji Medical College,Huazhong University of Science and Technology from Jan 2016 to Jan 2020 were studied.Patients were divided into pCR group and non-pCR group.Single factor analysis and Logistic multivariate regression analysis were performed to explore pCR related factors after nCRT,and a pCR prediction scoring system was established.Results The pCR was achieved in 33 patients(20.8%).Univariate analysis showed that the maximum thickness of the tumor≤25mm before nCRT(P=0.046),concurrent oxaliplatin-combined intensive chemotherapy(P=0.013),the NLR≤1.65 before nCRT(P=0.004)and the serum CEA≤5 ng/ml before nCRT(P=0.016)were significantly associated with pCR.In multivariate analysis,concurrent oxaliplatin-combined intensive chemotherapy,the NLR before nCRT and serum CEA before nCRT were independent related factors of pCR.The probability of pCR for patients with score of 0,1,2,and 3 was 42%(10/24),30%(19/63),5%(3/57)and 7%(1/15),respectively.The probability of pCR in patients with score≤1 point was 33%(29/87),and 6%(4/72)for score˃1 point(P˂0.001).The area under the curve of the scoring system is 0.729(95%CI:0.638-0.820,P˂0.001).Conclusions Concurrent oxaliplatin-combined intensive chemotherapy,NLR≤1.65 before nCRT and serum CEA≤5 ng/ml before nCRT are independent predictors of pCR in locally advanced middle and low rectal cancer and the scoring system constructed in combination with above indicators can effectively predict pCR.