本研究旨在探讨在放化疗和选择性侧向淋巴结清扫的总系膜切除（TME）前增加诱导化疗是否可以提高中、下位肛直肠癌患者的无病生存率。研究者查询了机构前瞻数据库，选取了2004年至2019年期间接受新辅助治疗并进行TME手术的临床II、III期、初发性、中、下位且高风险的肛直肠癌患者。使用倾向评分匹配，将接受诱导化疗的新辅助放化疗组（诱导-CRT组）和接受新辅助放化疗而没有进行诱导化疗的组进行比较。从715名合格的患者中选取了两组匹配患者各130例。CRT组的中位随访时间为5.4年，诱导-CRT组为4.1年。诱导-CRT组的3年无病生存率、远处转移无病生存率和局部复发无病生存率均显著高于CRT组（83.5% vs.71.4%，p = 0.015；84.3% vs.75.2%，p = 0.049；98.4% vs.94.4%，p = 0.048）。诱导-CRT组的病理完全缓解比率也高于CRT组（26.2% vs.10.0%，p < 0.001）。两组手术后严重并发症（Clavien-Dindo分类≥III）的差异没有显著性 (12.3% vs.10.8%，p = 0.698)。因此，在中、下位肛直肠癌患者进行选择性侧向淋巴结清扫的TME手术前加入诱导化疗似乎能显著改善患者的肿瘤学结局，包括无病生存率。©2023年外科肿瘤学会。

This study aimed to investigate whether the addition of induction chemotherapy before chemoradiotherapy (CRT) and total mesorectal excision (TME) with selective lateral lymph node dissection improves disease-free survival for patients with poor-risk, mid-to-low rectal cancer.The authors' institutional prospective database was queried for consecutive patients with clinical stage II or III, primary, poor-risk, mid-to-low rectal cancer who received neoadjuvant treatment followed by TME from 2004 to 2019. The outcomes for the patients who received induction chemotherapy before neoadjuvant CRT (induction-CRT group) were compared (via log-rank tests) with those for a propensity score-matched cohort of patients who received neoadjuvant CRT without induction chemotherapy (CRT group).From 715 eligible patients, the study selected two matched cohorts with 130 patients each. The median follow-up duration was 5.4 years for the CRT group and 4.1 years for the induction-CRT group. The induction-CRT group had significantly higher rates of 3-year disease-free survival (83.5 % vs 71.4 %; p = 0.015), distant metastasis-free survival (84.3 % vs 75.2 %; p = 0.049), and local recurrence-free survival (98.4 % vs 94.4 %; p = 0.048) than the CRT group. The pathologically complete response rate also was higher in the induction-CRT group than in the CRT group (26.2 % vs 10.0 %; p < 0.001). Postoperative major complications (Clavien-Dindo classification ≥III) did not differ significantly between the two groups (12.3 % vs 10.8 %; p = 0.698).The addition of induction chemotherapy to neoadjuvant CRT appeared to improve oncologic outcomes significantly, including disease-free survival, for the patients with poor-risk, mid-to-low rectal cancer who underwent TME using selective lateral lymph node dissection.© 2023. Society of Surgical Oncology.