Clinical Outcome of Rectal Cancer in Patients with or without Pathologic Complete Response after Preoperative Neoadjuvant Chemoradiotherapy: A Retrospective Analysis of a Single Institution in Taiwan

直腸癌患者接受術前同步放射及化學治療後有達到與未達到病理完全緩解的臨床預後之比較：在台灣單一機構的回顧性分析

黃基展(Chi-Chan Huang) ； 饒樹文(Shu-Wen Jao) ； 吳昌杰(Chang-Chieh Wu) ； 李家政(Chia-Cheng Lee) ； 李才宇(Tsai-Yu Lee) ； 蕭正文(Cheng-Wen Hsiao)

《中華民國大腸直腸外科醫學會雜誌》 24卷4期 (2013/12) Pp. 103-111

https://doi.org/10.6312/SCRSTW.2013.24(4).10206

摘要

目的：本研究探究接受術前放射及化學治療（CCRT）達到pCR（ypT0N0M0組）與未達完全緩解的患者（non-ypT0N0M0組）的療效和存活狀況。方法：回顧性分析了227位直腸癌患者的病歷。術前同步放射及化學治療（CCRT）中，放射線治療的總劑量是50.4 Gy，分25次完成，一周5次；化療則是每週靜脈注射一次5-氟尿嘧啶（1500 mg/m2）和亞葉酸鈣（120 mg/m2），共6周。所有患者在接受術前CCRT治療後6－8周內接受根治性切除術。比較兩組差異時，對連續型變項使用雙樣本t-test，對類別變項使用Chi-square test或Fisher's exact test。log-rank test和Kaplan-Meier生存曲線分析則用以比較總生存率（OS）和無病生存期（DFS）。結果：共計121 patients符合條件進入比較分析，其中19位為pCR（ypT0N0M0）組，102位為non-ypT0N0M0組。兩組患者的人口統計學和臨床特徵，療效與pCR無顯著相關性。兩組間的OS和DFS無顯著差異。兩組比較後，OS的p-value為0.643；DFS的pvalue為0.196，均未顯著。結論：術前接受CCRT的臺灣直腸癌患者的有無達到完全緩解和存活率無顯著差異。

關鍵字

直腸癌 ； 病理完全緩解 ； 新輔助化學及放射治療 ； 療效 ； 存活分析

並列摘要

Purpose. Preoperative concurrent chemoradiation (CCRT) is an important part of the therapeutic regimen to treat locally advanced rectal cancer. Patients who achieved a pathological complete response (pCR) after preoperative CCRT were shown to have a better clinical outcome compared to patients who did not. In this study, we investigated clinical outcome and survival in Taiwanese rectal cancer patients who achieved pCR after preoperative CCRT (ypT0N0M0 group) with patients who did not (nonypT0N0M0 group).Methods. In this retrospective study, we analyzed the records of 227 patients who presented with rectal adenocarcinoma. Preoperative concurrent chemo-radiation therapy (CCRT) consisted of a total dose of 50.4 Gy delivered in 25 fractions, five times per week. The chemotherapy regimen for preoperative CCRT consisted of an intravenous infusion of 5-fluorouracil (1,500 mg/m2) and leucovorin (120 mg/m2) weekly for 6 weeks. All patients underwent radical resection 6-8 weeks after preoperative CCRT treatment. Differences between patients with or without pCR were compared using two-sample t-tests in continuous data and Chi-square test/or Fisher's exact test with Yate's correction in categorical data. Overall survival (OS) and disease-free survival (DFS) were compared using log-rank test and Kaplan-Meier curves, respectively.Results. Atotal of 121 patients are eligible for analysis. 19 patients pertained to ypT0N0M0 and 102 patients belonged to non-ypT0N0M0 group. There was no significant association between demographics and clinical characteristics of the patients and pCR. There was no significant association between clinical outcome and pCR in the two groups. The log-rank test showed no significant difference in OS and DFS between the ypT0N0M0 and non-ypT0N0M0 groups.(OS: p-value = 0.643; DFS: p-value = 0.196).Conclusions. There was no significant difference in clinical outcome or survival between Taiwanese patients who achieved pCR after preoperative CCRT and those who did not.

並列關鍵字

Rectal cancer ； Pathologic complete response ； Neoadjuvant chemoradiation therapy ； Outcome ； Survival