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Objective:To evaluate the prognostic significance of neoadjuvant rectal (NAR) score and downstaging depth score (DDS) after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC).Methods:Retrospective analysis was performed for 200 patients with LARC (T 3-T 4 and/or N 1-N 2, M 0), who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2018. All patients had baseline MRI data and received preoperative nCRT and radical resection. All patients received preoperative radiotherapy with a dose of 45-50Gy combined with concurrent capecitabine. The effect of NAR and DDS scores on clinical prognosis was statistically compared. The 3-year disease-free survival (DFS) was calculated using the Kaplan- Meier method and compared by the log- rank test. Cox proportional hazards model was used to perform multivariate survival analysis. The predictive performance for 3-year DFS was calculated using the receiver operating characteristic (ROC) curve. Results:The median follow-up time was 30.5(10.6-54.0) months. In terms of DDS, the 3-year DFS rate was 56.4% in the DDS ≤0 group, significantly lower than 83.0% in the DDS >0 group ( P=0.002). In terms of NAR score, the 3-year DFS rates were 90.1%, 73.8% and 53.6% in NAR score ≤8, 8-16 and>16 groups, respectively ( P<0.001). In the whole cohort, the area under the ROC curve (AUC) of DDS and NAR scores for predicting 3-year DFS were 0.683 and 0.756( P=0.037). In yp0-I stage patients ( n=72), the AUC of DDS and NAR scores for predicting 3-year DFS were 0.762 and 0.569( P=0.032). Conclusions:High DDS and low NAR scores after nCRT indicate good prognosis for patients with LARC. NAR score yields better accuracy than DDS in predicting clinical prognosis, but DDS is significantly better than NAR score in yp0-I stage population.
ABSTRACT
Rectal cancer is one of the most common malignant tumors in China,and the proportion of elderly patients is also increasing.Due to the lack of prospective evidence-based medical research for elderly patients,no consensus on the optimal treatment model has been reached.In this article,relevant researches on the comprehensive treatment strategy of locally advanced rectal cancer in the elderly patients were reviewed,aiming to provide reference for individualized treatment of elderly patients.
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Rectal cancer is one of the most common malignant tumors in China, and the proportion of elderly patients is also increasing. Due to the lack of prospective evidence-based medical research for elderly patients, no consensus on the optimal treatment model has been reached. In this article, relevant researches on the comprehensive treatment strategy of locally advanced rectal cancer in the elderly patients were reviewed, aiming to provide reference for individualized treatment of elderly patients.
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Objective@#Short-course neoadjuvant radiotherapy (SCRT) combined with delayed surgery seems to be safer than SCRT in combination with immediate surgery. However, the clinical efficacy between SCRT and long-course neoadjuvant radiotherapy (LCRT) combined with delayed surgery has not been compared. Therefore, this meta-analysis was performed to compare the safety and efficacy between SCRT and LCRT followed by delayed surgery in patients with locally advanced rectal cancer.@*Methods@#Relevant literatures were searched using relevant databases. Baseline characteristics and treatment results of patients were extracted. The included studies were subject to bias risk assessment. Evidence assessment and data analysis were conducted.@*Results@#A total of 7 studies with 4967 patients were included. Meta-analysis results illustrated no statistical significance between two groups in terms of sphincter preservation rate, R0 resection rate, postoperative complications, local recurrence rate (LRR), distant metastasis, recurrence-free survival (RFS), overall survival (OS), length of hospital stay and acute radiotherapy toxicity (all P>0.05). Compared with SCRT with delayed surgery, LCRT with delayed surgery was associated with a significant increase in the tumor downstaging rate (RR=0.84, 95%CI=0.76-0.93, P<0.05) and a considerable increase in pathologically complete remission rate (RR=0.46, 95%CI=0.34-0.61, P<0.05).@*Conclusions@#SCRT with delayed surgery is as effective as LCRT with delayed surgery in terms of sphincter preservation rate, R0 resection rate, postoperative complications, LRR, RFS, OS, grade Ⅲ-Ⅳ acute toxicity and length of hospital stay. However, LCRT in combination with delayed surgery enhances the tumor downstaging rate and pathologically complete remission rate.
ABSTRACT
Objective At present, short-course radiotherapy ( SCRT) with immediate surgery and long-course chemoradiotherapy ( LCRT ) with delayed surgery are extremely important regimens in the treatment of rectal cancer. In this meta-analysis, the clinical efficacy and safety were statistically compared between two regimes. Methods Literatures related to SCRT and LCRT including randomized controlled studies and clinical studies were searched from Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure ( CNKI) and Wanfang database with regard to SCRT with immediate surgery or LCRT with delayed surgery. Meta-analysis was conducted by using RevMan 5.3 software. Results Ten studies were finally selected including 5 randomized controlled trials. Meta-analysis demonstrated that the RO resection rate, T downstaging rate, pathological complete response ( pCR) rate in the LCRT group were significantly higher than those in the SCRT group. The incidence rate of adverse events in the LCRT group was higher compared with that in the SCRT group. The sphincter-preservation rate, local recurrence rate, distant metastasis rate, disease-free survival rate, overall survival, late toxicity and postoperative complications did not significantly differ between two groups ( all P>0.05) . Conclusions Compared with SCRT, LCRT can increase the T downstaging rate, R0 resection rate and pCR rate, whereas elevate the incidence rate of acute adverse events. LCRT exerts no significant effect upon overall postoperative complications.