Международный эндокринологический журнал Том 21, №7, 2025

Актуальність. Існує велика варіабельність гістопатологічної відповіді в осіб із раком прямої кишки, яким проведено неоад’ювантну терапію і тотальну мезоректальну резекцію. Пацієнти, які досягли повної гістопатологічної відповіді, зазвичай мають кращі показники виживання й меншу частоту рецидивів. Тому точна оцінка відповіді на лікування є важливою для прийняття подальших терапевтичних рішень, включно зі стратегією збереження органа або локальною резекцією. Мета: оцінити гістопатологічну відповідь у кореляції з декількома клініко-патологічними прогностичними факторами в осіб із раком прямої кишки, які отримували неоад’ювантну терапію з подальшою тотальною мезоректальною резекцією. Матеріали та методи. Ретроспективне дослідження включало пацієнтів із локалізованим раком прямої кишки, які отримували неоад’ювантну терапію з подальшою тотальною мезоректальною резекцією. Застосовано логістичну регресію між пухлиною як залежною змінною величиною та клініко-патологічними ознаками як предикторами. Значення p < 0,05 вважалося статистично значущим. Результати. Під спостереженням перебувало 112 пацієнтів, 64 % з них — чоловіки. Середній вік становив 61,1 року (стандартне відхилення 12,0). Повна гістопатологічна відповідь спостерігалася в 17,86 % випадків. Установлено вірогідний зв’язок між ступенем регресування пухлини й станом циркулярного краю резекції (p = 0,009), патогістологічним ступенем (p = 0,001), післяопераційною Т-стадією (p = 0,001), периневральною інвазією (p = 0,001) та доопераційною Т-стадією (p = 0,008). Рецидив спостерігався у 12,5 % пацієнтів із вірогідним зв’язком для постнеоад’ювантної Т-стадії (p = 0,001), стану циркулярного краю резекції (p < 0,0001), патогістологічного ступеня (p = 0,04), периневральної інвазії (p = 0,004), інтервалу лікування (p = 0,02) та ступеня регресування пухлини (p = 0,002). Висновки. Стан циркулярного краю резекції, патогістологічний ступінь, периневральна інвазія, доопераційна Т-стадія та постнеоад’ювантна Т-стадія є значущими незалежними предикторами різних патологічних відповідей.

Background. There is a significant variability in histopathologic response in patients with rectal carcinoma treated by neoadjuvant therapy and total mesorectal excision. Patients achieving pathologic complete response generally have improved survival outcomes and reduced recurrence rates. Accurate assessment of treatment response is therefore essential to guide subsequent therapeutic decisions, including organ-preserving strategies or local excision. The purpose of this retrospective study is to assess histopathologic response in correlation with several clinicopathologic prognostic factors in patients with rectal carcinoma who received neoadjuvant therapy followed by total mesorectal resection. Materials and methods. A retrospective study included patients with localized rectal carcinoma treated by neoadjuvant therapy followed by total mesorectal excision. Multinomial logistic regression was performed with tumor regression grade as the dependent variable and clinicopathologic features as predictors. A p-value < 0.05 was considered statistically significant. Results. A total of 112 patients were encompassed, 64 % were men. The mean age was 61.1 years (SD 12.0). Pathologic complete response was observed in 17.86 % of patients. Significant associations were found between tumor regression grade and circumferential margin status (p = 0.009), histologic grade (p = 0.001), post-operative T stage (p = 0.001), perineural invasion (p = 0.001), and preoperative T stage (p = 0.008). Recurrence was seen in 12.5 % of patients, with significant associations for post-neoadjuvant T stage (p = 0.001), circumferential margin status (p < 0.0001), histological grade (p = 0.04), perineural invasion (p = 0.004), treatment interval (p = 0.02), and tumor regression grade (p = 0.002). Conclusions. Circumferential margin status, histologic grade, perineural invasion, preoperative T stage, and post-neoadjuvant T stage are significant independent predictors of different pathologic responses.

рак прямої кишки; повна гістопатологічна відповідь; неоад’ювантна терапія; патологічні прогностичні фактори

rectal cancer; pathologic complete response; neoadjuvant therapy; pathologic prognostic factors

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