Endoscopic and imaging evaluations of the primary tumor response in patients with proficient mismatch repair colorectal cancer treated with neoadjuvant combination immunotherapy.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Techniques in Coloproctology Pub Date : 2025-01-16 DOI:10.1007/s10151-024-03088-x

Yuegang Li, Chengcheng Han, Yao Cheng, Gang Hu, Meng Zhuang, Xishan Wang, Jianqiang Tang

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Abstract

Background: Neoadjuvant combination immunotherapy is a potential treatment option for patients with proficient mismatch repair/microsatellite stable colorectal cancer. Preoperative screening via endoscopy and imaging examinations could help identify patients who may potentially achieve a complete response after neoadjuvant combination immunotherapy. This study aims to evaluate the diagnostic accuracy of endoscopic and imaging examinations in predicting pathological complete response after neoadjuvant combination immunotherapy.

Methods: This single-center, retrospective, observational study included patients diagnosed with colorectal cancer by biopsy between 2015 and 2023 at a tertiary referral center. The main outcome measures included endoscopic examination, imaging findings, and pathological results after neoadjuvant combination immunotherapy.

Results: This study included 36 patients with locally advanced proficient mismatch repair colorectal cancer. Postoperative pathology revealed that 17 patients (47.2%) achieved a complete response (ypT0N0). The sensitivity, specificity, and accuracy of the endoscopic ypT0N0 diagnosis were 62.5%, 80.0%, and 80.6%, respectively; those of imaging-based ypT0N0 diagnosis were 43.8%, 100%, and 75.0%, respectively; and those of the combined diagnosis were 37.5%, 100%, and 72.2%, respectively. The areas under the receiver-operating characteristic curve for the endoscopic and imaging ypT0N0 diagnoses were 0.768 and 0.706, respectively.

Conclusions: The specificities of endoscopy and imaging for diagnosing complete response after neoadjuvant combination immunotherapy for colorectal cancer were high; however, sensitivities were low. Therefore, radical surgery should still be recommended for patients with an incomplete response based on either examination. Larger scale studies are required to determine if a watch-and-wait strategy is suitable for patients with a complete response based on these two examinations.

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内镜和影像学评价熟练错配修复结直肠癌患者接受新辅助联合免疫治疗的原发肿瘤反应。

背景：新辅助联合免疫治疗是精通错配修复/微卫星稳定型结直肠癌患者的潜在治疗选择。术前通过内窥镜检查和影像学检查筛查可以帮助确定在新辅助联合免疫治疗后可能达到完全缓解的患者。本研究旨在评估内镜和影像学检查在预测新辅助联合免疫治疗后病理完全缓解方面的诊断准确性。方法：这项单中心、回顾性、观察性研究纳入了2015年至2023年在三级转诊中心通过活检诊断为结直肠癌的患者。主要观察指标包括内镜检查、影像学表现和新辅助联合免疫治疗后的病理结果。结果：本研究纳入36例局部晚期熟练错配修复结直肠癌患者。术后病理显示17例（47.2%）患者获得完全缓解（ypT0N0）。内镜下诊断ypT0N0的敏感性、特异性和准确性分别为62.5%、80.0%和80.6%；基于影像学的ypT0N0诊断率分别为43.8%、100%和75.0%；综合诊断率分别为37.5%、100%、72.2%。内镜和影像学诊断的ypT0N0的受者工作特征曲线下面积分别为0.768和0.706。结论：内镜和影像学诊断结直肠癌新辅助联合免疫治疗后完全缓解的特异性较高；然而，灵敏度很低。因此，对于两种检查均无完全反应的患者，仍应建议进行根治性手术。需要更大规模的研究来确定观察和等待策略是否适用于基于这两项检查的完全反应的患者。

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来源期刊

Techniques in Coloproctology GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.30

自引率

9.10%

发文量

176

审稿时长

1 months

期刊介绍： Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.