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Patient Risk Subgroups Predict Benefit of Adjuvant Chemotherapy in Stage II Rectal Cancer Patients Following Neoadjuvant Chemoradiation and Total Mesorectal Excision
Clinical Colorectal Cancer ( IF 3.4 ) Pub Date : 2021-02-27 , DOI: 10.1016/j.clcc.2021.02.006
Samer Naffouje 1 , Arvind Sabesan 2 , Benjamin D Powers 3 , Sophie Dessureault 1 , Julian Sanchez 1 , Michael Schell 4 , Iman Imanirad 1 , Ibrahim Sahin 1 , Hao Xie 1 , Seth Felder 1
Affiliation  

Background

The benefit of adjuvant chemotherapy (AC) is unclear in stage II (cT3-T4 N0) rectal adenocarcinoma (RAC) after neoadjuvant chemoradiation (NCRT) and total mesorectal excision (TME). We aim to identify pathologic factors that influence overall survival (OS) and stratify patients into risk profiles to assess the AC benefit within each profile.

Patients and Methods

The National Cancer Database for rectal cancer was utilized to identify patients with stage II RAC who completed NCRT and TME. Cox multivariable analysis was used to identify pathologic predictors of 5-year OS, which were then used to construct a nomogram and stratify patients into low-, intermediate-, and high-risk subgroups. Propensity score matching was applied for the receipt of AC within each risk stratum, and Kaplan–Meier analysis was used to measure 5-year OS.

Results

We identified 3570 patients who met the inclusion criteria. Inadequate lymphadenectomy (<12), poor differentiation, involved distal margin, involved circumferential margin, perineural invasion, and absence of T-downstaging after NCRT were identified as unfavorable predictors of 5-year OS and were used to construct the nomogram. Kaplan–Meier analysis of the matched patients demonstrated the absolute 5-year survival benefits for each risk stratum as follows: 4% for low-risk patients (hazard ratio (HR) = 0.869; [0.651-1.021]; P = .062), 26% for intermediate-risk patients (HR, 0.249; [0.133-0.468]; P < .001), and 10% in high-risk patients (HR = 0.633 [0.427-0.940]; P = .024).

Conclusions

The survival benefit of AC for clinical stage II RAC following NCRT and TME is most pronounced among intermediate- and high-risk patients as determined by our nomogram. Risk-adaptive AC may be appropriate for selected patients by integrating standard reported pathologic elements into the treatment plan.



中文翻译:

患者风险亚组预测新辅助放化疗和全直肠系膜切除术后 II 期直肠癌患者辅助化疗的益处

背景

在新辅助放化疗 (NCRT) 和全直肠系膜切除 (TME) 后的 II 期 (cT3-T4 N0) 直肠腺癌 (RAC) 中,辅助化疗 (AC) 的益处尚不清楚。我们旨在确定影响总生存期 (OS) 的病理因素,并将患者分层为风险概况,以评估每个概况中的 AC 益处。

患者和方法

国家直肠癌癌症数据库用于识别完成 NCRT 和 TME 的 II 期 RAC 患者。Cox 多变量分析用于确定 5 年 OS 的病理预测因子,然后用于构建列线图并将患者分层为低、中、高风险亚组。倾向评分匹配应用于每个风险层内接受 AC,并使用 Kaplan-Meier 分析测量 5 年 OS。

结果

我们确定了 3570 名符合纳入标准的患者。淋巴结切除不充分 (<12)、分化差、累及远端边缘、累及周缘、神经周围浸润和 NCRT 后没有 T 降期被确定为 5 年 OS 的不利预测因素,并用于构建列线图。匹配患者的 Kaplan-Meier 分析表明,每个风险层的绝对 5 年生存获益如下:低风险患者为 4%(风险比 (HR) = 0.869;[0.651-1.021];P  = .062) ,中危患者为 26%(HR,0.249;[0.133-0.468];P < .001),高危患者为 10%(HR = 0.633 [0.427-0.940];P  = .024)。

结论

根据我们的列线图确定,AC 对 NCRT 和 TME 后临床 II 期 RAC 的生存益处在中高风险患者中最为明显。通过将标准报告的病理要素整合到治疗计划中,风险适应性 AC 可能适用于选定的患者。

更新日期:2021-02-27
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