tumorsMalignant tumoursMalignant tumours2224-50572587-6813Rosoncoweb10.18027/2224-5057-2024-14-1-9-20tumors-1284Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL REPORTSХирургическое лечение или неоадъювантная химиотерапия при раке верхнеампулярного отдела прямой кишки: ретроспективное исследованиеPreliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancerЛукмоновС. Н.LukmonovS.  N.

Лукмонов Саидрахим Нодирович

115478 Москва, Каширское шоссе, 23

Lukmonov Saidrahim Nodirovich

23 Kashirskoe Shosse, Moscow 115478

drrakhim46@gmail.comhttps://orcid.org/0000-0003-2163-1752БеленькаяЯ. В.BelenkayaY.  V.

 Беленькая Яна Владимировна

115478 Москва, Каширское шоссе, 23; 119991 Москва, ул. Трубецкая, 8, стр. 2

 

Belenkaya Yana Vladimirovna

23 Kashirskoe Shosse, Moscow 115478; Build. 2, 8 Trubetskaya St., Moscow 119991

https://orcid.org/0000-0002-9303-8379ГордеевС. С.GordeevS.  S.

Гордеев Сергей Сергеевич

115478 Москва, Каширское шоссе, 23; 625023 Тюмень, ул. Одесская, 54

 Gordeev Sergey Sergeevich

23 Kashirskoe Shosse, Moscow 115478; 54 Odesskaya St., Tyumen 625023

https://orcid.org/0009-0001-3660-3845СадыковА. Ж.SadikovA.  J.

Садыков Акбар Жахангирович

117997 Москва, ул. Островитянова д. 1

Sadikov Akbar Zhahangirovich

1 Ostrovityanova St., Moscow 117997

https://orcid.org/0000-0002-9289-1247МамедлиЗ. З.MamedliZ. Z.

Мамедли Заман Заурович

115478 Москва, Каширское шоссе, 23

Mamedli Zaman Zaurovich

23 Kashirskoe Shosse, Moscow 115478

ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России; ФГАОУ ВО Первый Московский государственный медицинский университет им. И.М. Сеченова Минздрава России (Сеченовский Университет)РоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; I. M. Sechenov First Moscow State Medical UniversityRussian FederationФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России; ФГБОУ ВО «Тюменский государственный медицинский университет» Минздрава РоссииРоссияN. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia; Tyumen State Medical UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияN. I. Pirogov Russian National Research Medical UniversityRussian Federation202415032024141920Copyright © Лукмонов С.Н., Беленькая Я.В., Гордеев С.С., Садыков А.Ж., Мамедли З.З., 20242024Лукмонов С.Н., Беленькая Я.В., Гордеев С.С., Садыков А.Ж., Мамедли З.З.Lukmonov S.N., Belenkaya Y.V., Gordeev S.S., Sadikov A.J., Mamedli Z.Z.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.malignanttumors.org/jour/article/view/1284Введение

Введение: В научной литературе имеется мало информации о роли неоадъювантной химиотерапии (НАХТ) при верхнеампулярном раке прямой кишки (в/а РПК), в связи с чем мы провели данное исследование. Цель нашего исследования — изучить роль НАХТ при в/а РПК.

Материалы и методы

Материалы и методы: Мы провели ретроспективное когортное многоцентровое исследование, в ходе которого проанализировали данные историй болезни больных в/а РПК из архива ФГБУ «НМИЦ онкологии им. Н.Н. Блохина» Минздрава России, ФГБУ «НМИЦ колопроктологии им. А.Н. Рыжих», ГБУЗ Ставропольского края «Ставропольский краевой клинический онкологический диспансер» и ГБУЗ Онкологического центра Калининградской области с 2007 по 2020 гг. Все пациенты были разделены на 2 группы: в 1 группу вошли больные, которым на 1 этапе лечения проводилась НАХТ, во 2 группу — те, кому на 1 этапе проводилось хирургическое вмешательство. Основным оцениваемым параметром была 3-летняя безрецидивная выживаемость (БРВ). Также оценивали частоту полного патоморфологического ответа (pCR), токсичность лечения, частоту послеоперационных осложнений (Clavien–Dindo), степень регрессии опухоли, частоту рецидивов и метастазов, 3-летнюю общую выживаемость (ОВ), частоту завершения полного курса.

Результаты

Результаты: В группу НАХТ включили 118 пациентов, в группу хирургии — 103 пациента. Исследуемые группы были сопоставимы по полу, статусу по шкале ASA и степени дифференцировки опухоли. Достоверно чаще поражение регионарных лимфоузлов было зафиксировано в группе НАХТ (р = 0,002). Медиана наблюдения составила 36,0 месяцев. При анализе 3-летней БРВ и ОВ достоверные различия не были выявлены. Частота развития рецидивов составила 3,9% в группе хирургического лечения и 0% в группе НАХТ (p = 0,046). Частота развития метастазов в исследуемых группах достоверно не различалась (p = 0,293). У 16 (13,6%) пациентов, получавших НАХТ, отмечался полный патологический ответ (pCR). Частота завершения полного курса НАХТ составила 91,5%. Гематологическая токсичность 3–4 степени наблюдалась у 4 пациентов (3,3%), негематологическая — у 4 пациентов (3,3%). Отмечена выраженная тенденция более частого развития несостоятельности анастомоза (НА) в группе хирургического лечения без проведения НАХТ (p = 0,07).

Выводы

Выводы: НАХТ имеет приемлемый профиль токсичности, не ухудшает онкологические результаты лечения и потенциально может быть использована для раннего начала системной терапии у отобранной группы пациентов.

Introduction

Introduction: There is a lack of information on the role of neoadjuvant chemotherapy in upper rectal cancer. The aim of our research was to investigate the role of neoadjuvant chemotherapy in upper rectal cancer treatment.

Materials and methods

Materials and methods: We conducted a retrospective cohort multicenter study to analyze the medical records of patients with upper rectal cancer from 2007 to 2020 obtained from the archive of Research Institute FSBI «N. N. Blokhin Cancer Research Center» of the Ministry of Health of Russia, A. N. Ryzhikh National Medical Research Centre for Coloproctology, Stavropol regional Clinical oncological Dispensary and Kaliningrad oncological Center. All patients were divided into 2 groups: group 1 included patients who underwent neoadjuvant chemotherapy with CAPOX as the first treatment step, and group 2 included patients who underwent upfront surgery. Primary endpoint was 3‑year disease-free survival (DFS) rate. We also estimated the pathological complete response (pCR) rate, treatment toxicity, postoperative morbidity rate (Clavien – Dindo), degree of tumor regression, local recurrence rate, distant metastases rate, 3‑year overall survival (OS) and the neoadjuvant chemotherapy completion rate.

Results

Results: 118 patients were included in the neoadjuvant chemotherapy group and 103 patients — in the surgery group. Study groups were well balanced and comparable for gender, the ASA status and the tumor differentiation grade. More patients in the neoadjuvant chemotherapy group had clinically positive lymph nodes (p = 0.002). Median follow-up period was 36 months. There were no significant differences in 3‑year OS and DFS. The local recurrence rate was 3.9 % in the surgery group versus 0 % in the neoadjuvant chemotherapy group (p = 0.046). There were no significant differences between study groups in the distant metastases rate (p = 0.293). Sixteen (13.6 %) patients had a pCR after neoadjuvant chemotherapy. The neoadjuvant chemotherapy completion rate was 91.5 %. The hematological toxicity grade 3–4 was observed in 3.3 % (4 patients), the non-hematological toxicity grade 3–4 in 3.3 % (4 patients).

Conclusion

Conclusion: NACT has an acceptable toxicity profile, does not impede oncological treatment results, and can be used in a selected group of patients for early systemic control.

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The authors declare that there are no conflicts of interest present.