Association of tumor circumferential involvement range with neoadjuvant therapy efficacy and long-term outcomes in locally advanced rectal cancer
10.3760/cma.j.cn112152-20240922-00409
- VernacularTitle:肿瘤环腔占比与局部进展期直肠癌新辅助治疗疗效和远期预后的关系
- Author:
Ganbin LI
1
;
Xiaoyuan QIU
1
;
Xiao ZHANG
1
;
Lai XU
1
;
Beizhan NIU
1
;
Guannan ZHANG
1
;
Junyang LU
1
;
Bin WU
1
;
Yi XIAO
1
;
Guole LIN
1
Author Information
1. 中国医学科学院北京协和医院基本外科，北京100730
- Publication Type:Journal Article
- Keywords:
Rectal neoplasms;
Locally advanced;
Neoadjuvant therapy;
Circumferential occupation range;
Efficacy
- From:
Chinese Journal of Oncology
2025;47(8):750-755
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To detect the association of tumor circumferential involvement range (CIR) with neoadjuvant chemoradiotherapy (NCRT) efficacy and long-term survival outcomes in locally advanced rectal cancer (LARC) patients.Methods:Clinical data of 451 patients admitted to our hospital from January, 2018 to January, 2022 were retrospectively collected. According to the CIRs as determined by rectal magnetic resonance imaging, patients were divided into the High group (≥2/3 cycle, 270 patients) and the Low group (＜2/3 cycle, 181 patients). The primary outcome was three-year disease-free survival. The baseline characteristics, pathological features, and survival outcomes were compared.Results:Compared to patients in the Low group, patients in the High group exhibited significantly larger tumor vertical diameters [(4.7±1.7) vs. (3.6±1.4)cm, P＜0.001], higher rates of mrT4 stage (37.8% vs. 13.2%, P＜0.001), and higher rates of positive mesorectal fascia (54.1% vs. 29.8%, P＜0.001) and extramural vascular invasion (55.6% vs. 38.1%, P＜0.001). Patients in the High group were mainly pT3-4 stages (46.7% vs. 30.9%, P=0.002), with significantly lower rates of pathological complete response (22.2% vs. 33.1%, P=0.010) , poorer tumor regression grades (48.9% vs. 60.8%, P=0.013), and higher rates of positive peripheral nerve invasion (11.5% vs. 5.5%, P=0.031), as compared to patients in the Low group. The median follow-up time was 40 months. About 11 (2.4%) and 48 patients (10.6%) experienced tumor local recurrence and distant metastasis, respectively. The recurrence rates were 2.2% and 2.6%, and the distant metastasis rates were 7.7% and 12.6%, respectively, in the Low group and the High group, with no statistical significance ( P=0.957, P=0.096). The three-year disease-free survival in the High group was significantly lower than that in the Low group (84.4% vs. 92.4%, P=0.014). Conclusions:The CIR is closely related to tumor burden, which can judge tumor response to NCRT, and is negatively related to survival prognosis. For patients who have more than a 2/3 cycle of CIR, intensified or consolidated treatments may be required to improve survival outcomes.
