直肠癌患者术前分期与新辅助方案决策和疗效的关系:基于DACCA的真实世界数据研究  

Associations between preoperative staging and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer:A real-world data study based on DACCA

作　　者：胡义銧 刘碧瑶 郑雅芳 李家睿 汪晓东[1] 王利亚 阳旭菻 邱航[3] HU Yiguang;LIU Biyao;ZHENG Yafang;LI Jiarui;WANG Xiaodong;WANG Liya;YANG Xulin;QIU Hang(Division of Gastrointestinal Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Medicine,Sichuan University,Chengdu 610041,P.R.China;School of Computer Science and Engineering,University of Electronic Science and Technology of China,Chengdu 611731,P.R.China)

机构地区：[1]四川大学华西医院普外科,胃肠外科病房,成都610041 [2]四川大学华西临床医学院,成都610041 [3]电子科技大学计算机科学与工程学院,成都611731

出　　处：《中国普外基础与临床杂志》2025年第4期448-454,共7页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省科技计划项目(项目编号:2024YFHZ0060);四川大学华西医院临床研究孵化项目(项目编号:2021HXFH052)。

摘　　要：目的分析当前版本华西肠癌数据库(Database from Colorectal Cancer,DACCA)中直肠癌患者的术前分期(cTNM)与新辅助方案决策和治疗效果的关系。方法本次数据分析选取的DACCA版本为2024年4月20日更新版,本研究中分析术前AJCC-TNM分期为Ⅱ、Ⅲ、Ⅳ期直肠癌患者的新辅助方案决策和新辅助治疗效果包括大体变化、影像变化、肿瘤退缩分级(tumor regression grade,TRG)的差异。结果本研究共收集到符合筛选条件的数据3158条,完整记录患者术前分期和新辅助治疗方案决策的数据共有2370条。术前不同分期患者对选择联合靶向治疗、放疗方案及选择新辅助化疗强度在不同分期直肠癌患者间总体比较差异均有统计学意义(χ^(2)=42.239,P<0.001;χ^(2)=41.615,P<0.001;H=1.161,P=0.004)。体现在,分期越晚,选择联合靶向治疗和联合放疗患者占比逐步升高;在不同分期患者选择中程化疗者占比最高,而且在分期越晚的患者中选择长程化疗者占比最高。术前不同分期患者接受新辅助治疗后大体变化、影像变化及TRG结果在不同分期直肠癌患者间总体比较差异均有统计学意义(H=7.860、P=0.020;H=9.845、P=0.007;H=6.680,P=0.035)。术前Ⅱ、Ⅲ、Ⅳ期患者新辅助治疗后大体变化和影像变化指标中占比最高者均是部分缓解患者,Ⅱ期患者完全缓解者占比最高;TRG指标在Ⅱ、Ⅲ、Ⅳ期直肠癌患者均是以TRG2级占比最高。结论通过DACCA中较大样本量的数据分析发现,分期越晚的患者选择化疗联合靶向治疗方案和联合放疗方案的比例越高,选择中程化疗的比例越高、新辅助化疗强度越强。新辅助治疗效果上,分期越早的大体变化、影像变化越良好,TRG级别越低。Objective To analyze the association between preoperative staging(cTNM)and neoadjuvant therapy regimen decision-making and efficacy in patients with rectal cancer in the current version of Database from Colorectal Cancer(DACCA).Methods The data analysis for this study selected the DACCA version updated on April 20,2024.The patient information was collected and categorized into three stages(Ⅱ,Ⅲ,andⅣ).The differences in neoadjuvant treatment decision-making and therapeutic effects,including gross changes,imaging changes,and tumor regression grade(TRG),were analyzed.Results A total of 3158 eligible cases were collected in this study,with complete preoperative staging and neoadjuvant therapy decision-making data available for 2370 patients.There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targete therapy,radiotherapy regimens,and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages(χ^(2)=42.239,P<0.001;χ^(2)=41.615,P<0.001;H=1.161,P=0.004).Specifically,the proportion of patients choosing combined targeted therapy and combined radiotherapy gradually increased as the stage advanced.Among patients at different stages,the proportion of those choosing medium-course chemotherapy was the highest,and the proportion of patients choosing long-course chemotherapy was the highest among those with more advanced stages.Regarding the gross changes,imaging changes,and TRG results after neoadjuvant treatment in the patients at different preoperative stages,there were statistically significant differences in the overall comparison among patients with stageⅡ,Ⅲ,andⅣrectal cancer(H=7.860,P=0.020;H=9.845,P=0.007;H=6.680,P=0.035).The proportion of partial response was the highest across all response metrics(macroscopic,radiographic,and TRG)in each stage.Notably,stageⅡpatients demonstrated the highest rate of complete response.For TRG evaluation,grade 2(TRG2)was the most common outcome across

关 键 词：术前分期 直肠癌 新辅助治疗 华西肠癌数据库 

分 类 号：R73[医药卫生—肿瘤]