The Effect of Total Neoadjuvant Treatment on Pathological Response and Survival in Locally Advanced Rectal Cancer: A Single Center Experience

IF 3.2 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-05-22 DOI:10.1016/j.clcc.2025.05.001

Okan Aydın , Ahmet Emin Öztürk , Mert Erciyestepe , Şermin Dinç Sonuşen , Zehra Sucuoğlu İşleyen , Selvi Tabak Dinçer , Emir Çelik , Kayhan Ertürk , Muhammed Mustafa Atcı

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引用次数: 0

Abstract

Background

Total neoadjuvant therapy (TNT) has emerged as a promising approach in the treatment of locally advanced rectal cancer (LARC), aiming to improve pathological complete response (pCR) and survival by eradicating micrometastases.

Purpose

We aimed to evaluate the effect of TNT, which has been applied to patients with LARC in our clinic since 2019, on pathological response and survival and to present real-life data.

Methods

The medical records of 116 patients with stage 3 locally advanced rectal cancer who were followed at our clinic between March 2019 and March 2024 and who received TNT were retrospectively analyzed. Patients with pCR and non-pCR and TRG 0-1 and 2-3 were compared.

Results

The median follow-up period was 24.5. All of these 116 patients, were stage 3 (mostly stage 3B). Surgery was performed in 106 patients after TNT and 10 patients (8.6%) were followed with nonoperative management (NOM). Pathological complete response (pCR) was achieved in 28 (26.5%) of these 106 patients. The number of CAP-TRG 1 patients (near-pCR) was 35 (33%) and the number of CAP-TRG 2-3 patients was 43 (40.5%). Complete and near-complete responses (pCR and near-pCR) were achieved in approximately 60% of patients. Two parameters showed statistical significance in the univariate analysis of factors affecting pCR; tumor distance from the anal verge > 10 cm increased pCR 7.2-fold (P = .02) and CEA level at diagnosis ≤ 5 ng/ml increased pCR 4.4-fold (P = .008). During follow-up, 10 patients developed recurrence and/or metastasis and 5 of these 10 patients died. The majority of treatment-related toxicities were manageable grade 1-2 toxicities.

Conclusion

These single center, real-world data provide a perspective on the impact of TNT on pathological response and survival in patients with LARC. TNT is an effective and safe treatment and has become the standard of care with increased pathological complete response rates.

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全新辅助治疗对局部晚期直肠癌病理反应和生存的影响：单中心经验。

背景：全新辅助治疗（TNT）已成为治疗局部晚期直肠癌（LARC）的一种很有前景的方法，旨在通过根除微转移来提高病理完全缓解（pCR）和生存率。目的：我们旨在评估TNT自2019年以来在我诊所应用于LARC患者的病理反应和生存的影响，并提供现实数据。方法：回顾性分析2019年3月~ 2024年3月在我院随访并接受TNT治疗的116例3期局部晚期直肠癌患者病历。比较pCR与非pCR患者及TRG 0-1、2-3。结果：中位随访时间为24.5。所有116例患者均为3期（大部分为3B期）。106例患者行手术治疗，10例（8.6%）患者行非手术治疗。106例患者中28例（26.5%）达到病理完全缓解（pCR）。CAP-TRG 1患者（近pcr） 35例（33%），CAP-TRG 2-3患者43例（40.5%）。在大约60%的患者中实现了完全和接近完全的反应（pCR和近pCR）。单因素分析中有两个参数有统计学意义；肿瘤距离肛门边缘bbb10 cm时pCR增加7.2倍（P = 0.02），诊断时CEA水平≤5 ng/ml时pCR增加4.4倍（P = 0.008）。随访期间，10例患者复发和/或转移，其中5例死亡。大多数治疗相关的毒性是可控的1-2级毒性。结论：这些单中心、真实世界的数据为TNT对LARC患者病理反应和生存的影响提供了视角。TNT是一种有效且安全的治疗方法，已成为病理完全缓解率提高的标准治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

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.