预测局部晚期直肠癌的存活率,并具有有效的化学放射治疗反应
Seijong Kim1, Jung Wook Huh1, Woo Yong Lee1
1Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
概括
对于局部晚期的直肠癌患者,他们对新辅助化学放射治疗有良好的反应,环切除边缘,临床N阶段和辅助化学疗法影响生存率. 这些因素指导治疗和随访,以获得更好的瘤治疗结果.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠道瘤学 胃肠道瘤学
背景情况:
- 局部晚期直肠癌 (LARC) 患者通常表现出良好的治疗反应和结果.
- 有限的数据存在于预后因素的生存在LARC完整或接近完整的响应后的新辅助疗法.
- 这项研究确定了这一特定患者亚组的关键生存预测因素.
研究的目的:
- 确定无病生存 (DFS) 和整体生存 (OS) 的预后因素.
- 分析LARC患者在新辅助化学放射治疗 (nCRT) 和手术后实现病理完整反应 (pCR) 或病理第一阶段 (pSI) 的存活率.
- 引导加强后续和治疗策略,以改善结果.
主要方法:
- 在2008年1月至2017年4月期间治疗的1394名LARC患者的回顾性分析.
- 选择了474名患者 (34.2%),在nCRT后实现了PCR或PSI,并进行了全腹腔切除术 (TME).
- 对DFS和OS的预后因素的统计分析.
主要成果:
- 161名患者 (34%) 实现了pCR.
- 周围切除边缘 (CRM) 状态和辅助化疗是DFS显著的预后因素 (p=0.011,p=0.022).
- 临床N阶段和辅助化疗显著影响了OS (p=0.035,p=0.015).
结论:
- CRM,临床N阶段和辅助化疗是对LARC患者的生存至关重要的预后因素,这些患者对nCRT有良好的反应.
- 阳性CRM和临床N (+) 阶段的患者可能受益于密集的随访.
- 建议辅助化疗作为这种患者群的有益治疗方法.
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