在一项大型多中心分析中，直肠癌全新辅助治疗后完全缓解的临床和治疗相关预测因素

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2026-05-01 Epub Date: 2026-02-05 DOI:10.1016/j.ctro.2026.101120

Georg W. Wurschi , Melanie Schneider , Jan-Niklas Becker , Bernd Frerker , Samuel M. Vorbach , Felix Ehret , Markus Diefenhardt , Fabian Schunn , Maria-Elena von Gruben , Marcel Büttner , Elgin Hoffmann , Alexander Rühle , Josephine Beier , Simone Ferdinandus , Maike Trommer , Ezgi Ceren Sahin , Julian Hlouschek , Kynann Aninditha , Daphne Schepers von Ohlen , Justus Kaufmann , Klaus Pietschmann

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引用次数: 0

摘要

直肠癌全新辅助治疗（TNT）后的完全缓解（CR）与良好的局部控制和非手术治疗（NOM）有关。实现高CR率是至关重要的。由于没有标准的TNT治疗方案，我们的目的是评估临床因素和不同治疗方案对CR率的影响。方法回顾性多中心分析（DRKS00033000）纳入2015年至2024年间接受TNT治疗的直肠癌患者。主要终点是CR。在多变量logistic回归模型中，预定义的临床和治疗变量被视为协变量，并被评估为CR的潜在预测因子。结果纳入的245例患者（男性181例）中位年龄62岁（Q1-Q3: 54-67），达到CR的113例（46.1%），其中69例（28.2%）为活跃吸烟者。107例（43.7%）患者行短期放疗（SCRT）。分别有65例（26.5%）和73例（29.8%）患者使用了以嘧啶为基础的单药放化疗或同时使用奥沙利铂。中位数为8个（Q1-Q3: 6-9）周期的巩固化疗。随着化疗周期的增加，CR的可能性增加（OR 1.19, 95% ci: 1.04-1.38）。与同期以嘧啶为基础的放化疗相比，SCRT与较低的CR率相关（OR 0.34, 95% ci: 0.16-0.74）。在5-FU中加入奥沙利铂并没有进一步增加CR率（OR 1.06, 95%-CI: 0.50-2.27）。非吸烟者更有可能发生CR （OR 1.92, 95% ci: 1.03-3.57）。ESMO肿瘤分型及治疗时间与CR无相关性。结论TNT治疗强度越大，CR率越高。戒烟可能是有益的，但需要外界的认可。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Clinical and treatment-related predictors of complete response after total neoadjuvant therapy for rectal cancer in a large multicenter analysis

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Clinical and treatment-related predictors of complete response after total neoadjuvant therapy for rectal cancer in a large multicenter analysis

Introduction

Complete response (CR) after total neoadjuvant therapy (TNT) in rectal cancer is linked to favorable local control and enables non-operative management (NOM). Achieving high CR rates is crucial. As no standard TNT protocol exists, we aimed to assess the impact of clinical factors and different protocols on CR rates.

Methods

Rectal cancer patients undergoing TNT with curative intent between 2015 and 2024 were included in this retrospective multicenter analysis (DRKS00033000). The primary endpoint was CR. Predefined clinical and therapeutic variables were treated as covariates and evaluated as potential predictors of CR in a multivariable logistic regression model.

Results

Among 245 included patients (181 men) with a median age of 62 (Q1-Q3: 54–67) years, 113 (46.1%) reached a CR. Of those, 69 (28.2%) were active smokers. Short-course radiotherapy (SCRT) was applied in 107 (43.7%) patients. Chemoradiotherapy with pyrimidine-based monotherapy or concomitant oxaliplatin was used in 65 (26.5%) and 73 (29.8%) of patients, respectively. A median of 8 (Q1-Q3: 6–9) cycles of consolidation chemotherapy was administered. The CR likelihood increased with each additional chemotherapy cycle (OR 1.19, 95%-CI: 1.04–1.38). SCRT was associated with lower CR rates (OR 0.34, 95%-CI: 0.16–0.74) compared with concomitant pyrimidine-based chemoradiotherapy. Adding concomitant oxaliplatin to 5-FU did not further increase CR rates (OR 1.06, 95%-CI: 0.50–2.27). CR was more likely in non-smokers (OR 1.92, 95%-CI: 1.03–3.57). ESMO tumor classification and treatment duration were not associated with CR.