Oncological Outcomes of Patients with Rectal Cancer Who Received Surgery after Clinically Complete Response to Neoadjuvant Chemoradiotherapy

經前導性治療後臨床完全緩解之直腸癌病患接受手術之預後探討

張耀仁(Yao-Jen Chang) ； 黃約翰(John Huang) ； 洪基翔(Ji-Shiang Hung) ； 陳姿君(Tzu-Chun Chen) ； 梁金銅(Jin-Tung Liang)

《中華民國大腸直腸外科醫學會雜誌》 33卷2期 (2022/06) Pp. 99-108

https://doi.org/10.6312/SCRSTW.202206_33(2).11107

摘要

Purpose. To investigate the oncological outcomes of rectal cancer patients who received surgery after clinically complete response to neoadjuvant chemoradiation therapy. Methods. We retrospectively analyzed 25 patients with rectal cancer who achieved clinically complete response after neoadjuvant chemoradiation therapy and subsequently underwent surgical treatment from January 1, 2007, to December 31, 2018, at a single medical center. Their demographic and clinicopathological data were recorded, and the oncological outcomes were analyzed. Results. 25 patients with cT2-3N0-2 rectal cancer were enrolled. Of 25 patients, 5 (20%) had residual cancer cells after neoadjuvant chemoradiation therapy followed by surgical treatment. The mean age of all patients was 57.7 years, and 68% were men. Elevated carcinoembryonic antigen levels (＞ 5 ng/mL) were found in 28% patients at the time of initial diagnosis. The median follow-up time was 65 (range: 5.7-164) months. The 5-year overall survival and disease-free survival rates were 82.3% and 80.1%, respectively. A subgroup analysis revealed that patients with ypN0 might show a better outcome. Conclusions. The oncological outcomes of the present study were favorable. There were 20% of patients who had residual cancer and may benefit from radical surgery. However, there were still 16% patients who received abdominoperineal resection, even with pathologically complete response. Hence, careful considerations from clinicians to ascertain whether patients with radical surgery, especially among those who have achieved clinically complete response, would be essential.

關鍵字

Rectal cancer ； Neoadjuvant chemoradiotherapy (nCRT) ； Clinically complete response (cCR) ； Pathological complete response (pCR)

並列摘要

目的：探討經前導性治療後完全緩解之直腸癌病患接受手術治療之腫瘤學預後。方法：本回溯性研究分析25位經前導性化學治療及放射線治療後達成臨床完全緩解且接受手術之直腸癌病患。個案來源於單一醫療中心，蒐集期間為2007年1月至2018年12月，並追蹤至2021年。我們整理病患臨床資訊、腫瘤分期與病理結果，並分析三年及五年之無疾病存活率與五年整體存活率。結果：本研究收案25位直腸癌臨床分期cT2-3N0-2之病患，有5位病患於前導性治療及手術後發現殘餘癌細胞。平均年齡為57.7歲，68%的病患為男性。28%的病患於診斷時有異常之癌胚胎抗原（carcinoembryonic antigen ＞ 5 ng/mL）。術後追蹤時間中位數為65個月。五年整體存活率與五年無疾病存活率各為82.3%及80.1%。術後病理無殘留淋巴轉移者有較佳之預後。結論：本研究之預後為可接受的。有20%病患達成臨床完全緩解後仍有殘餘之癌細胞，且可能因手術而得到較佳預後。然而，有16%病患接受腹部會陰切開術，且術後診斷為病理完全緩解。因此，對於臨床完全緩解之直腸癌病患，臨床醫師須謹慎考慮根治性手術是否會使病患受益。

並列關鍵字

直腸癌 ； 前導性治療 ； 臨床完全緩解 ； 病理完全緩解

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