基于最初TNM分期和肿瘤大小的局部晚期直肠癌肿瘤反应率：共享决策的实用工具

Tumor response rates based on initial TNM stage and tumor size in locally advanced rectal cancer: a useful tool for shared decision-making

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Techniques in Coloproctology

影响因子:2.9

分区:医学3区 / 胃肠肝病学3区外科3区

发表日期:2024 Sep 10

作者: M Boubaddi, C Fleming, V Assenat, M-O François, E Rullier, Q Denost

DOI: 10.1007/s10151-024-02993-5

摘要

肿瘤的分期和大小被普遍认为影响局部晚期直肠癌（LARC）新辅助治疗的反应。迄今为止，关于器官保存的研究涵盖了多种大小和TNM分期的肿瘤。本研究旨在根据每个相关的TNM分期和肿瘤大小报告肿瘤反应。纳入2014年至2021年接受治疗的LARC患者，肿瘤为cT2-3NxM0，接受或不接受诱导化疗的放化疗。根据诊断时盆腔MRI（cTNM）进行肿瘤分期和最大径线长度计算肿瘤大小。临床反应依据治疗后盆腔MRI和手术（如有）后病理反应定义。采用IBM SPSS Statistics™，第20版进行统计分析。分析数据包括432例患者：cT2N0（n=51）、cT2N+（n=36）、cT3N0（n=76）、cT3N+（n=270）。完全或接近完全反应（cCR或nCR）比例从cT2N0 ≤3cm的77%降至cT3N+ >4cm的20%。在无复发的2年内，器官保存率分别为cT2N0 86%、cT2N+ 50%、cT3N0 39%、cT3N+ 12%。肿瘤反应明显随肿瘤分期和大小变化，反应程度与TNM分期和肿瘤大小呈反比关系。这些数据可助于优化患者筛选、实现器官保护计划的个体化，以及促进共享决策。

Abstract

It is accepted that tumor stage and size can influence response to neoadjuvant therapy in locally advanced rectal cancer (LARC). Studies on organ preservation to date have included a wide variety of size and TNM stage tumors. The aim of this study was to report tumor response based on each relevant TNM stage and tumor size.Patients treated with LARC from 2014 to 2021 with cT2-3NxM0 tumors who received neoadjuvant chemoradiotherapy with or without induction chemotherapy were included. Tumors were staged and tumor size calculated on pelvic MRI at the time of diagnosis (cTNM). Tumor size was based on the largest dimension taken on the longest axis of each tumor. Clinical response was defined on the basis of post-treatment pelvic MRI and pathological response following surgery, when performed. Statistical analysis was performed using IBM SPSS Statistics™, version 20. Data from 432 patients were analyzed as follows: cT2N0 (n = 51), cT2N+ (n = 36), cT3N0 (n = 76), cT3N+ (n = 270).The rate of complete or near-complete response (cCR or nCR) varied from 77% in cT2N0 ≤ 3 cm to 20% in cT3N+ > 4 cm. Organ preservation without recurrence at 2 years was achieved in 86% of patients with cT2N0, 50% in cT2N+, 39% in cT3N0, and 12% in cT3N+.There is significant variation in tumor response according to tumor stage and size. Tumor response appears inversely proportional to increasing TNM stage and tumor size. This data can support both refinement of selective patient recruitment to organ preservation programs and shared decision-making.