两种评分方法对局部晚期直肠癌同期放化疗+手术的预后预测价值比较

目的 比较新辅助直肠(NAR)评分和降期深度评分(DDS)对直肠癌新辅助同期放化疗后疗效的预测。方法 回顾分析2015—2018年间医科院肿瘤医院初治的局部晚期(T3-T4和/或N1-N2M0期)、具有疗前MRI资料、接受术前长程同期放化疗(CRT)+TME手术治疗直肠癌患者 200例资料。全盆腔外照射剂量为 45~50Gy,同期予以卡培他滨化疗。比较DDS、NAR评分对预后影响。应用Kaplan-Meier法计算无瘤生存(DFS)并log-rank法检验,Cox模型多因素分析。利用ROC曲线进行DFS预测能力评估。结果 中位随访时间为30.5个月(10.6~54.0个月)。DDS≤0者 3年DFS率为56.4%,>0者为83.0%(P=0.002)。NAR评分≤8者 3年DFS率为90.1%,8~16者和>16者分别为73.8%和53.6%(P=0.000)。全组患者中DDS和NAR评分预测 3年DFS的ROC曲线AUC值分别为0.683和0.756(P=0.037);yp0-Ⅰ期(72例)患者中DDS和NAR评分预测 3年DFS的ROC曲线AUC值分别为0.762和0.569(P=0.032)。结论 局部晚期新辅助同期放化疗+手术治疗患者中高DDS或低NAR评分提示预后良好。两种评分模式预测预后的准确性上NAR评分显著好于DDS,但在降期为yp0-Ⅰ期患者中DDS显著优于NAR评分。

Comparison of the value of two scores for predicting prognosis in patients with locally advanced rectal cancer undergoing concurrent chemoradiotherapy plus surgery

Objective To evaluate the prognostic significance of neoadjuvant rectal (NAR) score and downstaging depth score (DDS) after neoadjuvant chemoradiotherapy (nCRT) for locally advanced rectal cancer (LARC). Methods Retrospective analysis was performed for 200 patients with LARC (T3-T4 and/or N1-N2,M0), who were initially treated in the Cancer Hospital of Chinese Academy of Medical Sciences from 2015 to 2018. All patients had baseline MRI data and received preoperative nCRT and radical resection. All patients received preoperative radiotherapy with a dose of 45-50Gy combined with concurrent capecitabine. The effect of NAR and DDS scores on clinical prognosis was statistically compared. The 3-year disease-free survival (DFS) was calculated using the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards model was used to perform multivariate survival analysis. The predictive performance for 3-year DFS was calculated using the receiver operating characteristic (ROC) curve. Results The median follow-up time was 30.5(10.6-54.0) months. In terms of DDS, the 3-year DFS rate was 56.4% in the DDS ≤0 group, significantly lower than 83.0% in the DDS >0 group (P=0.002). In terms of NAR score, the 3-year DFS rates were 90.1%, 73.8% and 53.6% in NAR score ≤8, 8-16 and>16 groups, respectively (P<0.001). In the whole cohort, the area under the ROC curve (AUC) of DDS and NAR scores for predicting 3-year DFS were 0.683 and 0.756(P=0.037). In yp0-I stage patients (n=72), the AUC of DDS and NAR scores for predicting 3-year DFS were 0.762 and 0.569(P=0.032). Conclusions High DDS and low NAR scores after nCRT indicate good prognosis for patients with LARC. NAR score yields better accuracy than DDS in predicting clinical prognosis, but DDS is significantly better than NAR score in yp0-I stage population.