Clinical Outcomes in T4 and/or N2 Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy: A Retrospective Study

IF 3.3 3区 医学 Q2 ONCOLOGY
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Abstract

Introduction

Total neoadjuvant therapy (TNT) in the management of locally advanced rectal cancer (LARC) did not show survival benefit over the standard long course chemoradiotherapy. Trials of TNT did not address the impact of each risk feature in isolation from other high-risk features.

Methodology

In this retrospective study, we describe the clinical outcomes of patients with T4 and/or N2 rectal adenocarcinoma who were treated with chemoradiotherapy followed by total mesorectal excision (TME). After obtaining the local regulatory approvals, demographic and clinical data were collected for patients in Manitoba between January 2007 and December 2019.

Results

The cohort included 331 patients. 61 patients had T4-only disease and 218 had N2-only disease. Mean age was 59.65 years. 74.3% received adjuvant chemotherapy (ACT), but only 56.5% completed the planned course. R0 resection was achieved in 93.4% of patients (78.7% and 97.2% in T4 and N2, respectively). Median follow up was 4.93 years. 3-year overall recurrence rate was 29%. 3-year locoregional recurrence (LRR) rate was 8% (16% and 6% in T4 and N2, respectively). 3-year overall survival (OS) rate was 84% in the whole cohort (72.6% and 87.1% in T4 and N2, respectively). Incomplete surgical resection was a poor prognostic factor for both OS and LRR. ACT was associated with a survival benefit in the whole cohort (P = .001) and in the N2 sub-cohort (P = 003) but there was no survival benefit observed in T4 sub-cohort. ACT did not have an impact on LRR.

Conclusions

Achieving R0 resection in LARC with neoadjuvant therapy improves recurrence and survival rates. T4 disease carries a worse clinical outcome than N2 and consideration should be given to upstage T4 to stage III. Different high-risk features in LARC predict different clinical outcomes. In the era of TNT, personalization of treatment strategy based on these factors could potentially improve outcomes.

采用新辅助化放疗治疗 T4 和/或 N2 直肠癌的临床疗效;一项回顾性研究
导言在治疗局部晚期直肠癌(LARC)的过程中,新辅助治疗(TNT)与标准的长疗程化放疗相比并未显示出生存获益。方法在这项回顾性研究中,我们描述了T4和/或N2直肠腺癌患者接受化放疗后进行全直肠系膜切除术(TME)的临床结果。在获得当地监管部门批准后,研究人员收集了2007年1月至2019年12月期间马尼托巴省患者的人口统计学和临床数据。61名患者仅患有T4疾病,218名患者仅患有N2疾病。平均年龄为59.65岁。74.3%的患者接受了辅助化疗(ACT),但只有56.5%的患者完成了计划疗程。93.4%的患者实现了R0切除(T4和N2分别为78.7%和97.2%)。中位随访时间为4.93年。3年总复发率为29%。3年局部复发率(LRR)为8%(T4和N2分别为16%和6%)。整个组群的3年总生存率(OS)为84%(T4和N2分别为72.6%和87.1%)。手术切除不彻底是OS和LRR的不良预后因素。在整个队列(P = .001)和N2亚队列(P = 003)中,ACT与生存获益相关,但在T4亚队列中未观察到生存获益。结论LARC患者通过新辅助治疗实现R0切除可提高复发率和生存率。T4疾病的临床预后比N2差,因此应考虑将T4提升至III期。LARC的不同高危特征预示着不同的临床结局。在 TNT 时代,基于这些因素的个性化治疗策略有可能改善预后。
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来源期刊
Clinical colorectal cancer
Clinical colorectal cancer 医学-肿瘤学
CiteScore
5.50
自引率
2.90%
发文量
64
审稿时长
27 days
期刊介绍: Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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