Introduction: In rectal cancer, the choice of treatment strategy depends on the tumor stage and the response to neoadjuvant therapy. Accurate assessment of tumor regression through magnetic resonance imaging (MRI) may help to guide personalized approaches, including delayed or nonoperative management. This study aimed to assess the correlations between pathological complete response (pCR) and clinical staging before and after neoadjuvant treatment in rectal cancer patients. Methods: We conducted a retrospective analysis of rectal cancer patients treated with neoadjuvant therapy followed by radical resection in our oncological surgery department between July 2012 and December 2024. Clinical staging and tumor response were assessed using MRI, focusing on T- and N-stage evaluation. Pathological complete response (pCR) was defined as the absence of tumor cells on histopathological examination. Associations between pCR and clinical variables were explored. Results: Out of a total of 1693 rectal cancer patients, 783 (46.25%) received neoadjuvant therapy, with 62 patients (7.92%) presenting pCR. The majority had tumor stage cT3 (n= 45, 72.6%) and lymph node stage cN2b (n= 25, 40.3%) before treatment. Post-treatment MRI showed complete tumor response (T0) in 20 patients (32.3%) and nodal downstaging to N0 in 34 patients (54.8%). MRI provided imaging findings that indicate a limited correlation between clinical assessment of tumor response and pathological outcome. Six patients (9.6%) developed distant metastases, and there were no local recurrences. Conclusions: While MRI provides valuable preoperative information, its accuracy in predicting pCR remains limited. Achieving pCR is a favorable prognostic indicator, but it does not eliminate the risk of distant metastasis; therefore, continued surveillance and individualized management strategies remain essential to optimize outcomes in rectal cancer patients.
引言：在直肠癌治疗中，治疗策略的选择取决于肿瘤分期及对新辅助治疗的反应。通过磁共振成像（MRI）准确评估肿瘤消退情况，有助于指导个体化治疗策略，包括延迟手术或非手术治疗。本研究旨在评估直肠癌患者新辅助治疗前后病理完全缓解（pCR）与临床分期之间的相关性。方法：我们对2012年7月至2024年12月期间在肿瘤外科接受新辅助治疗后行根治性切除的直肠癌患者进行回顾性分析。采用MRI评估临床分期及肿瘤反应，重点关注T分期和N分期。病理完全缓解（pCR）定义为组织病理学检查未见肿瘤细胞。探讨了pCR与临床变量之间的关联。结果：在1693例直肠癌患者中，783例（46.25%）接受新辅助治疗，其中62例（7.92%）达到pCR。治疗前多数患者肿瘤分期为cT3（n=45，72.6%），淋巴结分期为cN2b（n=25，40.3%）。治疗后MRI显示20例患者（32.3%）肿瘤完全消退（T0），34例患者（54.8%）淋巴结降期至N0。MRI影像学表现提示，肿瘤反应的临床评估与病理结果之间的相关性有限。6例患者（9.6%）出现远处转移，无局部复发。结论：尽管MRI可提供有价值的术前信息，但其预测pCR的准确性仍有限。达到pCR是良好的预后指标，但并未完全消除远处转移的风险；因此，持续监测和个体化管理策略对于优化直肠癌患者的预后仍至关重要。
肿瘤(癌症)患者之家