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Paolo Goffredo¹, Mohammed O Suraju², Sarah L Mott³

¹Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. goffr002@umn.edu.

Annals of surgical oncology

|May 30, 2024

概括

总的新辅助疗法 (TNT) 增加了局部晚期直肠癌 (LARC) 的病理完整反应 (pCR) 率,但没有改善整体存活率. 到pCR的途径,不仅仅是实现它,影响患者的结果.

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:

在新辅助化学辐射治疗 (nCRT) 后的病理完整反应 (pCR) 与局部晚期直肠癌 (LARC) 的更好的生存率有关.
总的新辅助疗法 (TNT) 通过在手术前结合化疗和化疗辐射来升级治疗,增加pCR率.
尽管pCR率较高,但TNT与标准nCRT相比并没有改善整体存活率 (OS).

研究的目的:

调查实现pCR的方法是否会影响LARC患者的瘤结果.
为了比较通过不同的新辅助治疗策略实现的pCR的预后意义.

主要方法:

来自国家癌症数据库 (2006-2017) 的25880名成年LARC患者的回顾性分析.
纳入标准:新辅助辐射 (45-70 Gy) 和乳腺切除术.
患者按治疗方式分类:TNT,nCRT与多剂辅助化疗,单剂辅助化疗或没有辅助化疗.

主要成果:

16%的患者接受了TNT; 84%接受了nCRT.
总体PCR率为18%,在TNT队列中观察到的比率更高.
在pCR队列中,单剂和多剂辅助疗法组的OS类似,但优于TNT和没有辅助疗法组. 在非pCR患者中,在TNT,多剂和单剂组中,OS是可比的,所有这些都优于没有辅助治疗.

结论:

与单独使用nCRT相比,通过TNT实现pCR与更差的生存状况有关,这表明pCR的途径具有预后意义.
在新辅助疗法不断升级的背景下,单独使用PCR可能无法保证均有利的预后.
这些发现表明,在激化LARC的新辅助治疗方案时代,需要重新评估pCR的解释.

关键词:

新辅助剂化学辐射疗法总体生存率总体生存率病理学完整的反应反应.这是直肠癌.总的新辅助疗法治疗.

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