Neoadjuvant rectal score in prognostic prediction of clinical stage Ⅲ middle-low rectal cancer
10.3760/cma.j.issn.1004-4221.2018.05.007
- VernacularTitle:新辅助治疗评分预测临床Ⅲ期中低位直肠癌预后研究
- Author:
Shuai LI
1
;
Jing JIN
;
Feng YE
;
Yuan TANG
;
Ning LI
;
Jing YU
;
Hua REN
;
Xin WANG
;
Yang Wen LIU
;
Shulian WANG
;
Yongwen SONG
;
Weihu WANG
;
Yueping LIU
;
Hui FANG
;
Ning Ning LU
;
Yu TANG
;
Shunan QI
;
Bo CHEN
;
Yexiong LI
Author Information
1. 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院放疗科
- Keywords:
Local advanced rectal neoplasms/neoadjuvant chemoradiotherapy;
Downstaging;
Neoadjuvant rectal score;
Prognosis
- From:
Chinese Journal of Radiation Oncology
2018;27(5):467-472
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of downstaging and neoadjuvant reetal(NAR) score on the prognosis of patients with clinical stage Ⅲ middle-low rectal cancer undergoing preoperative concurrent chemoradiotherapy.Methods From 2006 to 2014,195 patients who were admitted to our hospital and diagnosed with clinical stage Ⅲ middle-low rectal cancer by pelvic magnetic resonance imaging or computed tomography were enrolled.All patients received preoperative radiotherapy with doses of 42-50.4 Gy (median:50 Gy,93.8％ of patients received doses of ≥ 50 Gy) and concurrent chemotherapy with capecitabine ± oxaliplatin.Total mesorectal (R0) excision surgery was performed at 4-15 weeks (median:7 weeks) after concurrent chemoradiotherapy.The effects of downstaging (stage yp0-Ⅱ) and NAR score (calculated based on cT staging and ypT/N staging) on the prognosis were evaluated.The 3-year disease-free survival (DFS) rate was calculated using the Kaplan-Meier method and analyzed by log-rank test.Results In all the patients,the median follow-up time was 44 months (6.7-125.5 months);the 3-year DFS rate was 76.8％.Downstaging after preoperative chemoradiotherapy was a significant prognostic factor for the 3-year DFS (92.2％ vs.56.8％,P=0.000).The median NAR score was 15.0(0-65.0) in all the patients.Patients with NAR scores of ≤ 15.0 had significantly improved 3-year DFS than those with NAR scores of＞15.0(90.1％ vs.57.0％,P=0.001).In patients with downstaging,those with NAR scores of ≤8.4 had significantly improved prognosis compared with those with NAR scores of＞ 8.4(95.1％ vs.87.5％,P=0.022).Conclusions Patients with downstaging after preoperative concurrent chemoradiotherapy for stage c Ⅲ middle-low rectal cancer have satisfactory prognosis.The NAR score is an effective prognostic predictor.
