Περίληψη:
Background Locally advanced rectal cancer is usually treated with
preoperative chemoradiation. After chemoradiation and surgery, 15-27%
of the patients have no residual viable tumour at pathological
examination, a pathological complete response (pCR). This study
established whether patients with pCR have better long-term outcome than
do those without pCR.
Methods In PubMed, Medline, and Embase we identified 27 articles, based
on 17 different datasets, for long-term outcome of patients with and
without pCR. 14 investigators agreed to provide individual patient data.
All patients underwent chemoradiation and total mesorectal excision.
Primary outcome was 5-year disease-free survival. Kaplan-Meier survival
functions were computed and hazard ratios (HRs) calculated, with the Cox
proportional hazards model. Subgroup analyses were done to test for
effect modification by other predicting factors. Interstudy
heterogeneity was assessed for disease-free survival and overall
survival with forest plots and the Q test.
Findings 484 of 3105 included patients had a pCR. Median follow-up for
all patients was 48 months (range 0-277). 5-year crude disease-free
survival was 83.3% (95% CI 78.8-87-0) for patients with pCR (61/419
patients had disease recurrence) and 65.6% (63.6-68.0) for those
without pCR (747/2263; HR 0.44, 95% CI 0.34-0.57; p<0.0001). The Q test
and forest plots did not suggest significant interstudy variation. The
adjusted HR for pCR for failure was 0.54 (95% CI 0.40-0.73), indicating
that patients with pCR had a significantly increased probability of
disease-free survival. The adjusted HR for disease-free survival for
administration of adjuvant chemotherapy was 0.91 (95% CI 0.73-1.12).
The effect of pCR on disease-free survival was not modified by other
prognostic factors.
Interpretation Patients with pCR after chemoradiation have better
long-term outcome than do those without pCR. pCR might be indicative of
a prognostically favourable biological tumour profile with less
propensity for local or distant recurrence and improved survival.
Συγγραφείς:
Maas, Monique
Nelemans, Patty J.
Valentini, Vincenzo
Das,
Prajnan
Roedel, Claus
Kuo, Li-Jen
Calvo, Felipe A. and
Garcia-Aguilar, Julio
Glynne-Jones, Rob
Haustermans, Karin and
Mohiuddin, Mohammed
Pucciarelli, Salvatore
Small, Jr., William
and Suarez, Javier
Theodoropoulos, George
Biondo, Sebastiano and
Beets-Tan, Regina G. H.
Beets, Geerard L.
