HU Yiguang 1,2 , LIU Biyao 1,2 , ZHENG Yafang 1,2 , LI Jiarui 1,2 , WANG Xiaodong 1 , WANG Liya 1 , YANG Xulin 3 , QIU Hang 3
  • 1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
  • 2. West China School of Medicine, Sichuan University, Chengdu 610041, P. R. China;
  • 3. School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China;
WANG Xiaodong, Email: wangxiaodong@wchscu.cn
preoperative staging; rectal cancer; neoadjuvant treatment; Database from Colorectal Cancer
10.7507/1007-9424.202502029
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Objective To analyze the association between preoperative staging (AJCC-TNM) 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, and Ⅳ). 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 3 158 eligible cases were collected in this study, with complete preoperative staging and neoadjuvant therapy decision-making data available for 2 370 (75.0%) patients. There were statistically significant differences in the overall comparison among the patients with rectal cancer in terms of the selection of combined targeted therapy, radiotherapy regimens, and the intensity of neoadjuvant chemotherapy by patients at different preoperative stages (χ²=42.239, P<0.001; χ²=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 stage Ⅱ, Ⅲ, and Ⅳ rectal 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, stage II patients demonstrated the highest rate of complete response. For TRG evaluation, grade 2 (TRG2) was the most common outcome across all stages. Conclusions Data analysis from DACCA reveals that patients with advanced stages are more likely to choose chemotherapy combined with targeted therapy or radiotherapy, and had a higher proportion of intermediate range chemotherapy and the intensity of neoadjuvant chemotherapy is stronger. In terms of neoadjuvant treatment effects, the earlier the staging, the better the gross and imaging changes, and the lower the TRG level.

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