新辅助治疗反应对局部进展期直肠癌患者预后的影响

目的探究新辅助治疗反应对局部进展期直肠癌患者远期预后的影响。 方法回顾性收集中国医学科学院肿瘤医院218例接受术前新辅助放化疗的局部进展期直肠癌患者（LARC）的临床病理资料。根据Dowrak/R?del肿瘤退缩分级（TRG）标准将患者分为治疗反应良好（TRG3~4）和治疗反应不佳（TRG0~2）。采用Cox风险比例回归单因素和多因素分析确定无病生存（disease-free survival，DFS）和肿瘤总生存（overall survival，OS）影响因素。采用Kaplan-Meier法绘制生存曲线并利用Log-rank检验比较肿瘤生存差异。 结果本研究纳入患者218例，其中治疗反应良好126例，治疗反应不佳92例。单因素和多因素Cox回归分析确定新辅助治疗反应不佳是DFS（HR=3.85，95%CI：1.40~10.60；P=0.009）和OS（HR=3.81，95%CI：1.02~14.20；P=0.046）的独立危险因素。5年DFS分别为反应良好93.46%，反应不佳65.04%（χ²=28.23，P＜0.001）；5年OS分别为反应良好95.38%，反应不佳78.99%（χ²=18.51，P＜0.001）。 结论新辅助治疗反应是LARC患者DFS和OS的独立预后因素；良好的治疗反应预示着更好的肿瘤学预后，为进一步的临床研究风险分层提供了理论基础。

The prognostic impact of neoadjuvant therapy response on survival in patients with locally advanced rectal cancer

ObjectiveTo explore the prognostic impact of neoadjuvant therapy response on survival in patients with locally advanced rectal cancer. MethodsThe clinicopathological data of 218 patients with locally advanced rectal cancer (LARC) who received preoperative neoadjuvant chemoradiotherapy in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively collected. Patients were divided into good response (TRG3~4) and poor response (TRG0~2) based on Dowrak/R?del tumor regression grade (TRG) criteria. Cox proportional regression univariate and multivariate analyses were performed to identify the influence factors for disease-free survival (DFS) and overall survival (OS). Kaplan-Meier method was used to plot the survival curve and the Log-rank test was used to compare the differences in tumor survival. ResultsA total of 218 patients were enrolled in this study, including 126 patients with good treatment responses and 92 patients with poor treatment responses. Univariate and multivariate Cox regression analysis identified that poor response to neoadjuvant therapy was an independent risk factor for DFS (HR=3.85, 95%CI: 1.40~10.60; P=0.009) and OS (HR=3.81, 95%CI: 1.02~14.20; P=0.046). 5-year DFS was 93.46% in the good response group and 65.04% in the poor response group (χ²=28.23, P＜0.001); and 5-year OS were 95.38% in the good response group and 78.99% in the poor response group (χ²=18.51, P＜0.001). ConclusionNeoadjuvant therapy response was an independent prognostic factor for DFS and OS in locally advanced rectal cancer patients, and good response predicts better oncology prognosis. This study provides a theoretical basis for further clinical research on risk stratification.