错配修复完整或微卫星稳定型局部晚期直肠癌不同模式新辅助治疗效果比较  

Efficacy comparison of different modes of neoadjuvant therapy for locally advanced rectal cancer with proficient in mismatch repair intact or microsatellite stability

作　　者：宋迪 石永刚[1] 韩晓丹 Song Di;Shi Yonggang;Han Xiaodan(Department of Radiotherapy,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放疗科,郑州450052

出　　处：《肿瘤研究与临床》2025年第1期8-13,共6页Cancer Research and Clinic

基　　金：河南省医学科技攻关计划(LHGJ20230289)。

摘　　要：目的探讨错配修复完整(pMMR)或微卫星稳定(MSS)型局部晚期直肠癌(LARC)不同模式新辅助治疗的效果。方法回顾性病例系列研究。选取2020年1月至2022年12月郑州大学第一附属医院收治的210例pMMR或MSS型LARC患者,根据新辅助治疗模式分为单纯化疗组(98例)和全程新辅助治疗(TNT)组(112例),比较组间病理完全缓解(pCR)率。TNT组中24例患者接受短程放疗(SCRT)+化疗(A组),62例患者接受SCRT+化疗+免疫治疗(B组),23例患者接受长程放疗(LCRT)+化疗(C组),3例患者接受LCRT+化疗+免疫治疗(D组);比较组间pCR率、肿瘤分期下调及不良反应发生率。对于肿瘤距肛门距离>5 cm且TNM分期为T2~3N0~2M0的87例患者进行亚组分析,分为单纯化疗组(47例)和TNT组(40例),比较两组患者总生存(OS)及无病生存(DFS)。结果210例患者中,男性126例,女性84例;年龄(51±11)岁;临床分期Ⅱ期3例,Ⅲ期207例;肿瘤距肛门距离<5 cm 68例,≥5 cm 142例。TNT组pCR率高于单纯化疗组[40.2%(45/112)比7.2%(7/98)],差异有统计学意义(χ2=30.62,P<0.001)。D组1例患者达到pCR,因样本量少未进行统计学比较。A组pCR率与C组差异无统计学意义[25.0%(6/24)比21.7%(5/23),χ2=0.07,P=0.792]。B组pCR率高于A组和C组[53.2%(33/62)比25.0%(6/24),53.2%(33/62)比21.7%(5/23)],差异均有统计学意义(χ2=5.56,P=0.029;χ2=6.73,P=0.013)。A、B、C组间T、N分期下调发生率差异均无统计学意义(均P>0.05)。TNT组新辅助治疗期间3~4级骨髓抑制发生率为10.7%(12/112),未见3~4级放射性直肠炎。B组粒细胞减少发生率低于A组,血小板减少发生率低于C组,差异均有统计学意义(均P<0.05)。亚组分析中单纯化疗组与TNT组间OS、DFS差异均无统计学意义(χ2=2.17,P=0.141;χ2=0.24,P=0.624)。结论pMMR或MSS型LARC患者采用SCRT联合免疫治疗的新辅助治疗模式具有高pCR率,且安全性好。TNT不能改善中高位低危LARC患者生存,且可能有过度治疗的风险。ObjectiveTo investigate the therapeutic efficacy of different modes of neoadjuvant therapy for locally advanced rectal cancer(LARC)with proficient in mismatch repair intact(pMMR)or microsatellite stability(MSS).MethodsA retrospective case series study was conducted.A total of 210 LARC patients with pMMR or MSS admitted to the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022 were selected.Patients were divided into the chemotherapy alone group(98 cases)and the total neoadjuvant therapy(TNT)group(112 cases)based on different neoadjuvant treatment modes.The pathological complete remission(pCR)rate of both groups was compared.In the TNT group,24 patients received short-course radiotherapy(SCRT)plus chemotherapy(group A),62 patients received SCRT plus chemotherapy combined with immunotherapy(group B),23 patients received long-course radiotherapy(LCRT)plus chemotherapy(group C),and 3 patients received LCRT plus chemotherapy combined with immunotherapy(group D).The pCR rate,tumor down-staging and the incidence of adverse reactions were compared between the 4 groups.A subgroup analysis was performed in 87 patients with the distance from the tumor site to anal verge>5 cm and T 2-3N 0-2M 0 TNM staging.And then 87 patients were divided into the chemotherapy alone group(47 cases)and the TNT group(40 cases),and the overall survival(OS)and disease-free survival(DFS)of patients were compared between the 2 groups.ResultsAmong the 210 LARC patients,126 cases were male and 84 cases were female,with the age of(51±11)years.There were 3 cases in clinical stageⅡand 207 cases in clinical stageⅢ;68 cases with the distance from the tumor site to the anal verge<5 cm and 142 cases with the distance from the tumor site to the anal verge≥5 cm.The pCR rate of the TNT group was higher than that of the chemotherapy alone group[40.2%(45/112)vs.7.2%(7/98)],and the difference was statistically significant(χ2=30.62,P<0.001).In group D,1 patient achieved pCR,but no statistical comparison was made due to th

关 键 词：直肠肿瘤 全程新辅助治疗 短程放疗 免疫检查点抑制剂 

分 类 号：R735.37[医药卫生—肿瘤]