在接受新辅助疗法的不完全临床反应后拒绝手术的直肠癌患者的结果
Kevin P Labadie1, Kristofor A Olson1, Steven H Sun1
1Division of Colorectal Surgery, Duarte, California, USA.
Journal of surgical oncology
|February 24, 2024
概括
对于在新辅助疗法后拒绝手术的直肠癌患者,有些人达到完全反应和延长生存时间. 仔细监测,特别是对于那些几乎完全响应的人来说,是关键.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 全腹膜切除术 (TME) 是直肠癌后新辅助治疗的标准.
- 一些患者的TME下降,需要替代的管理策略.
- 了解这些患者的治疗结果至关重要.
研究的目的:
- 评估在新辅助疗法后拒绝TME的直肠癌患者的临床结果.
- 为了比较TME,观察和等待 (WW) 和拒绝TME,辅导和观察 (RCW) 组之间的结果.
- 评估不同管理途径中的资源利用情况.
主要方法:
- 对171名直肠腺癌患者 (1-3期) 的回顾性队列研究.
- 患者接受了新辅助化学辐射或全新辅助疗法 (TNT).
- 分析的群体:TME,WW和RCW (拒绝了TME).
主要成果:
- 17%的患者拒绝了TME,显示总生存率 (OS) 降低.
- 拒绝TME的12名患者实现了完整的临床反应 (cCR) 与延长的OS.
- 在初始内镜上接近cCR (92%) 预测RCW组的良好结果.
结论:
- 显著比例的患者拒绝TME实现cCR和改善的OS.
- 延长cCR评估的时间框架可能有利于选择患者,特别是那些最初接近cCR的患者.
- 这表明,在特定的直肠癌病例中,非手术治疗可能发挥作用.
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