Introduction: Colorectal cancer is the fourth leading cause of cancer-related death in both men and women in our population. In this regard, rectal cancer accounts for more than half of colorectal cancer deaths, and its incidence is expected to increase in the coming years. There have been significant changes in neoadjuvant therapy regimens, with promising results, as demonstrated by the recent RAPIDO and PRODIGE23 studies. Around 40% of patients diagnosed with locally advanced rectal cancer show some degree of response to neoadjuvant treatment, with complete tumor regression observed in up to one in five patients. Materials and Methods: Retrospective observational study. A total of 181 patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy followed by surgery were analyzed. Clinical and pathological data were collected from the patients, including assessment of tumor regression through histopathological studies after surgery. The Mandard tumor regression grading system was used to categorize tumor response into different grades. Results: The results showed a significant association between the degree of tumor regression and several important clinical outcomes. Specifically, patients with higher tumor regression had significantly better disease-free survival than those with less regression (p= 0.004). In addition, tumor regression was also correlated with the incidence of local recurrence (p= 0.018) and distant metastasis (p= 0.032). These associations suggest that tumor responsiveness to neoadjuvant therapy may influence the long-term progression of the disease. Regarding tumor deposits and the presence of lymphadenopathy, these factors were also found to be significantly associated with clinical outcomes. Patients with tumor deposits had a higher incidence of local recurrence (p= 0.025) and distant metastases (p= 0.041), while the presence of lymphadenopathy increased the risk of local recurrence (p= 0.013). These findings highlight the importance of evaluating not only tumor regression but also other pathological markers to predict prognosis and guide clinical management. Conclusions: The degree of tumor regression was not an independent predictor of survival compared to other variables such as nodal stage and presence of tumor deposits. This indicates that while tumor regression is an important factor, other elements also play a crucial role in determining the prognosis of patients with locally advanced rectal cancer. This study provides additional evidence for the importance of tumor regression, tumor deposits, and lymphadenopathy as predictors of clinical outcomes in patients with rectal cancer treated with neoadjuvant chemoradiotherapy.
引言：结直肠癌是我国男性和女性癌症相关死亡的第四大原因。其中直肠癌占结直肠癌死亡病例半数以上，且其发病率预计在未来数年将持续上升。新辅助治疗方案已发生显著变革，近期RAPIDO和PRODIGE23研究显示其疗效前景可观。约40%的局部晚期直肠癌患者对新辅助治疗呈现不同程度应答，其中高达五分之一的患者可实现肿瘤完全消退。 材料与方法：本研究为回顾性观察性研究。共纳入181例接受新辅助放化疗后手术治疗的局部晚期直肠癌患者。收集患者临床及病理学资料，包括术后通过组织病理学检查评估肿瘤消退情况。采用Mandard肿瘤消退分级系统对肿瘤应答程度进行分级。 结果：研究显示肿瘤消退程度与多项重要临床结局存在显著关联。具体而言，肿瘤消退程度较高的患者无病生存期显著优于消退程度较低者（p=0.004）。此外，肿瘤消退程度还与局部复发率（p=0.018）及远处转移率（p=0.032）相关。这些关联表明肿瘤对新辅助治疗的应答可能影响疾病长期进展。关于肿瘤沉积和淋巴结病变，研究发现这些因素同样与临床结局显著相关：存在肿瘤沉积的患者局部复发率（p=0.025）和远处转移率（p=0.041）更高，而淋巴结病变则增加局部复发风险（p=0.013）。这些发现提示，在预测预后和指导临床管理时，除评估肿瘤消退外，还需重视其他病理标志物的评估价值。 结论：与淋巴结分期、肿瘤沉积等其他变量相比，肿瘤消退程度并非独立的生存预测因子。这表明虽然肿瘤消退是重要因素，但其他因素在决定局部晚期直肠癌患者预后方面同样发挥关键作用。本研究进一步证实了肿瘤消退程度、肿瘤沉积及淋巴结病变作为新辅助放化疗直肠癌患者临床结局预测指标的重要性。
肿瘤(癌症)患者之家