不要指望通过腔内完全缓解来确定直肠癌的病理完全缓解！

IF 2.2 4区医学 Q2 MEDICINE, GENERAL & INTERNAL

Clinics Pub Date : 2025-01-01 DOI:10.1016/j.clinsp.2025.100587

Alexandre Gheller , Guilherme Inácio Bertoldo de Melo e Patriarca da Silva Neiva , Mario Nóbrega de Araújo Neto , Fernando Gonçalves Lyrio , Dunya Bachour Basílio , Marília Cristina Roda da Costa , Douglas Vieira Mourão , Paulo Gonçalves de Oliveira , João Batista de Sousa

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引用次数: 0

摘要

目的探讨直肠癌放化疗后腔内完全缓解与病理完全缓解的关系，并确定病理完全缓解的预测因素。方法回顾2013年至2017年连续102例接受新辅助放化疗后直肠切除术的直肠癌患者的解剖病理报告，分析是否存在腔内完全缓解。将腔内完全缓解的存在与解剖病理分期进行比较。将残余病变面积与最终病理分期进行比较，以确定完全缓解的预测因素。结果102例患者中，20例（19.6%）达到病理完全缓解（ypT0N0）。其中9例（45%）未达到腔内完全缓解。存在腔内完全缓解对鉴别ypT0N0的敏感性为55.00%，特异性为96.34%，准确性为88.24%。病理完全缓解（ypT0N0）与有腔内完全缓解、残余病变面积≤4cm2、肿瘤位于直肠中部相关。结论有病理完全缓解的患者中有近一半没有达到腔内完全缓解。位于直肠中部且残留大小≤4cm2的肿瘤和存在腔内完全缓解与ypT0N0的实现显著相关。

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Do not expect an endoluminal complete response to identify a pathologic complete response in rectal cancer!

Purpose

To examine the relationship between endoluminal and pathologic complete response after chemoradiotherapy for rectal cancer and identify predictors of a pathologic complete response.

Method

The anatomic pathology reports of 102 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by proctectomy between 2013 and 2017 were reviewed for the presence or absence of endoluminal complete response. The presence of endoluminal complete response was compared with the anatomopathological stage. The residual lesion area was compared with the final pathologic stage to identify predictors of complete response.

Results

Of 102 patients, 20 (19.6 %) achieved a pathologic complete response (ypT0N0). Of these, 9 (45 %) did not achieve an endoluminal complete response. The presence of endoluminal complete response had a sensitivity of 55.00 %, specificity of 96.34 %, and accuracy of 88.24 % to identify ypT0N0. The presence of endoluminal complete response, residual lesion area ≤ 4 cm², and tumor located in the mid-rectum were associated with pathologic complete response (ypT0N0).

Conclusion

Almost half of the patients who had a pathologic complete response did not achieve an endoluminal complete response. Tumors located in the mid-rectum with a residual size of ≤ 4 cm² and the presence of endoluminal complete response were significantly associated with the achievement of ypT0N0.

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来源期刊

Clinics 医学-医学：内科

CiteScore

4.10

自引率

3.70%

发文量

129

审稿时长

52 days

期刊介绍： CLINICS is an electronic journal that publishes peer-reviewed articles in continuous flow, of interest to clinicians and researchers in the medical sciences. CLINICS complies with the policies of funding agencies which request or require deposition of the published articles that they fund into publicly available databases. CLINICS supports the position of the International Committee of Medical Journal Editors (ICMJE) on trial registration.