Nat Commun: What local patients with advanced rectal cancer can benefit from chemotherapy?

Local advanced rectal cancer (LARC) is the most common form of rectal cancer.
although the combined treatment of new assisted radiotherapy and total rectal excision (TME) can reduce the local recurrence rate to 5-10%, it does not significantly improve the survival rate.
metastasis (DM) is the main cause of treatment failure in LARC patients, and the occurrence rate of DM remains at 25-40%.
to reduce the incidence of DM, rectal cancer guidelines recommend that PATIENTs undergo complementary chemotherapy after TME.
, however, complementary chemotherapy can only reduce the risk of DM and provide additional survival benefits only in some subgroups of patients, some of which may even get worse results after treatment.
, how to detect LARC patients who can benefit from complementary chemotherapy is critical.
recently, chinese researchers published a paper in the journal Nature Communications, which developed and validated an MRI-based radiological feature (RS) in a multi-center data set to predict distant transfers.
time of non-transferable lifetime (DMFS) in the distance was 49.6 months in the original queue (four-digit range: IQR: 47.3-52.6 months) and 52 in validation queue 1 .6 months (IQR: 50.3-58.9 months), 43.1 months in validation queue 2 (IQR:42.3-45.7 months), 46. 3 months (IQR: 45.2-48.2 months).
When comparing the results of five radiologists with those of the same radiologist at baseline and after at least one month, the researchers observed satisfactory repetition between and within observers of tumor masking and radioactive feature extraction (ICC>0.6).
addition, RS has proven to be an independent prognostic factor because it not only shows good accuracy across all four queues, distinguishing patients as high and low risk of DM, but also superior to clinical models.
to identify patients who could benefit from complementary chemotherapy, the researchers conducted experiments on the interaction between radiological characteristics, pathological stages, and the efficacy of complementary chemotherapy.
tests of the efficacy of radiological signs and auxiliary chemotherapy showed that patients with high radiological signs benefited worse from complementary chemotherapy than patients with low radiological signs (HR:1.706, 95% CI: 1.131-2.572, P 0.05; interactive test P 0.001).
-assisted chemotherapy was significantly associated with a decrease in DMFS in the highly radioactive marker group (P s 0.01), not significantly in the low radiological marker group, and only slightly significantly in all patients (P s 0.087).
results suggest that patients with LARC with high radioactivity may experience worse outcomes after receiving complementary chemotherapy.
the radiological characteristics and pathological stages showed that in all patients, the pT and pN stages were associated with DMFS (Figure 4b, c).
late stages suggest a high risk of DM, i.e. lower DMFS in patients with higher stages.
specifically, the pT stage is significantly related to DMFS in the high-radiological marker group (HR:1.620, 95% CI:1.140-2.303, P-lt;0.05), while the pN stage is significantly related to the DMFS in the high and low radiological marker group (HR in the high radiology feature group: 1. 904,95% CI: 1.526-2.375, P 0.05, HR:2.108, 95% CI: 1.141-3.895, P 0.05).
) at the same time, the pathological stages and auxiliary chemotherapy efficacy of the high and low radiological marker group were interactively tested.
the results of the
pT subgroup analysis showed that in the high-radiological marker group, pT1-2 patients did not benefit from complementary chemotherapy (HR:11.661, 95% CI: 1.531-88.825, p-0.003; interaction P-lt;0.001), but no significant interaction was observed in the low-radiological marker group.
pN subgroup analysis showed that pN0 patients with high radiological signs and assisted chemotherapy had even worse survival than patients with high radiological signs but no complementary chemotherapy (HR:2.666,95% CI:1. 269-5.601, p s 0.007; interactive p.lt;0.001), while in the low-radiation characteristic group, only pN2 patients benefited from survival from complementary chemotherapy (2 HR: 0.177,95% CI: 0.029-1.064, p s 0.033; interactive p slt;0.001).
, these data suggest that radiological characteristics may contribute to the development of individualized treatment plans and help clinicians select patients who may benefit from complementary chemotherapy for long-term control.
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