RESUMO
Antecedentes: La radioquimioterapia neoadyuvante es uno de los pilares del tratamiento del cáncer de recto localmente avanzado. La neoadyuvancia ha demostrado disminuir la recidiva local, generando también un downstaging tumoral, llegando incluso a una respuesta patológica completa (RPC), esta última relacionada con una mejor sobrevida global (SG) y sobrevida libre de enfermedad (SLE). Objetivo: Reportar los resultados anátomo-patológicos del tratamiento con radioquimioterapia en cáncer de recto, analizando su relación con la SG y la SLE. Material y Método: Estudio de cohorte prospectivo. Se analiza base de datos de cirugías coloproctológicas del Hospital Clínico de la Universidad de Chile, entre los años 20042019, incluyendo pacientes con cáncer de recto medio y bajo localmente avanzados, los cuales recibieron neoadyuvancia y posteriormente cirugía. Se realizó el análisis de sobrevida con el método de Kaplan-Meier y el test Log-rank para su comparación. Se consideró estadísticamente significativo un valor de p < 0,05. Resultados: 411 pacientes fueron operados por cáncer de recto, 143 pacientes recibieron neoadyuvancia, el 19% registró RPC. La SG del grupo con RPC fue 94% (IC 95%; 59,79-79,41%) mientras que la del grupo sin RPC fue 71% (IC 95%; 66,64-99,20%) (p = 0,018), la SLE en aquellos pacientes con RPC alcanzó un 100%, mientras que en aquellos sin RPC fue 74% (IC 95%; 64,08-81,28) (p = 0,008). Conclusiones: Los pacientes con RPC mostraron mejores resultados a largo plazo que aquellos sin RPC. La RPC podría indicar un perfil tumoral biológico favorable, con menos tendencia a la recurrencia y mejor supervivencia.
Background: One of the mainstays in the treatment of locally advanced rectal cancer is neoadjuvant chemoradiotherapy. Neoadjuvant therapy have demonstrated to decrease local recurrence, also generating tumor downstaging, even leading to a pathological complete response (PCR), the latter related to better overall survival (OS) and disease-free survival (SLE). Aim: To report the anatomo-pathological results of treatment with chemoradiotherapy in rectal cancer, analyzing the relationship with OS and SLE. Material and Method: Prospective cohort study. A database of colorectal surgeries from the Clinical Hospital of the University of Chile between the years 2004-2019, including patients with locally advanced low and middle rectal cancer, who received neoadjuvant and later surgery. Survival analysis was made with the Kaplan-Meier method and the Log-rank test for comparison. A value of p < 0.05 was considered statistically significant. Results: 411 patients underwent surgery for rectal cancer, 143 patients received neoadjuvant therapy, 19% registered PCR. The OS of the group with PCR was 94% (95% CI; 59.79-79.41%) while that of the group without PCR was 71% (95% CI; 66.64-99.20%) (p = 0.018), the SLE in those patients with PCR reached 100%, while in those without PCR it was 74% (95% CI; 64.08-81.28) (p = 0.008). Conclusions: Patients with PCR have better long-term results than those without PCR. PCR could indicate a favorable biological tumor profile, with less tendency to recurrence and improved survival.
RESUMO
Objective: To investigate causes and factors affecting microcalcification (MC) changes after neoadjuvant chemotherapy (NAC) in patients with breast cancer and to assess the correlation between MC reduction and complete remission rate [pathological complete response (pCR)] of tumors. Methods: Clinical data of 215 patients with breast cancer who visited Tianjin Medical University Cancer Hospital from January 1, 2015 to December 31, 2018 were collected. The patients were grouped according to MC range and number of changes, and factors that affected MC changes were evaluated. According to whether MC decreased or not, the patient group was divided into the MC range and MC number reduction groups, and the correlation between the decrease in MC and pCR, assessed using different molecular typing methods, was analyzed . The sensitivity and specificity of the receiver operating characteristic curve analysis (ROC) were used to evaluate the accuracy of MC reduction in predicting pCR. Results: The patients with a distribution of diffuse, initial MC range of >2 cm and MC quantity of >20 were more likely to have an MC reduction. The pCR rate was higher in the group with reduced and non-reduced MC. No significant difference was found between the group with decreased MC and the control group. The decreases in MC according to the different molecular typing methods were independent of factors affecting pCR. Reduction in MC range predicts pCR with a sensitivity of 77.78 and specificity of 57.45 (P=0.0001). Conclusions: The change factors of MC in patients with breast cancer after neoadjuvant chemotherapy were the range, number, and distribution of calcification. The pCR rate of the patients with reduced MC was high, but the accuracy of pCR prediction based on reduced MG was low. Thus, mammography was not recommended for evaluating pCR after neoadjuvant chemotherapy.
RESUMO
In recent years,neoadjuvant treatment followed by esophagectomy has been the standard treatment strategy for locally advanced esophageal cancer.Pathological response,especially complete pathological response (pCR),indicates better overall survival.With respect to complete clinical response (cCR) after neoadjuvant treatment,some researchers propose that definitive chemoradiotherapy could be an alternative to esophageetomy.The authors analyze and summarize correlation between cCR and pCR,and survival benefits of watch and wait after cCR.The authors think cCR alone could not be the precondition for the debate,unless combined with an effective predition of pCR based on clinical and molecular biomarkers.In this way,a prudent selection of patients followed by optimal therapy could be an important direction of individual management for locally advanced esophageal cancer.