在非手术治疗直肠癌后复发的危险因素
Neal Bhutiani1, Kentaro Ochiai1, Oliver Peacock1
1Department of Colon and Rectal Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Annals of surgical oncology
|February 9, 2025
概括
对于在新辅助疗法后实现完整反应的直肠癌患者,高风险的MRI特征,如外壁血管入侵和阳性骨盆侧壁节点,预测瘤再生. 建议仔细考虑非操作性管理.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 手术瘤学手术瘤学
背景情况:
- 在新辅助疗法后获得完整临床响应 (cCR) 的直肠癌患者可以接受非手术治疗 (NOM).
- 这些患者中的一小部分患者经历了瘤再生,需要进行救援手术.
- 识别预测再生的因素对于优化NOM患者选择至关重要.
研究的目的:
- 为了确定与瘤复发相关的临床病理因素,在新辅助疗法后非手术治疗的直肠癌患者.
- 通过预测复发风险来改善非手术治疗 (NOM) 的患者选择.
主要方法:
- 对单个NCI指定的综合癌症中心的直肠癌患者的回顾性分析,这些患者接受了基于cCR或近cCR的NOM.
- 根据随访期间瘤再生的发生情况对患者进行分层.
- 对瘤和治疗细节的比较,以确定影响无再生生长存活 (RFS) 的因素.
主要成果:
- 在125名患者中,20.8%的患者经历了局部再生,6.4%的患者患有远程转移.
- 外围血管侵袭 (EMVI) 和临床积极的骨盆侧壁淋巴结 (PSW) 与更糟糕的RFS显著相关 (HR 2.48,p=0.03;HR 2.77,p=0.002).
- 在第一次内镜评估时,近cCR的患者趋向于更高的RFS (HR 2.12,p=0.07) 并显示1年复发的显著差异 (HR 5.58,p=0.03).
结论:
- 高风险的MRI特征,特别是EMVI和阳性PSW节点,预测了临床反应的直肠癌患者的瘤再生.
- 几乎完全的内镜反应也可能表明随后瘤再生的风险更高.
- 采取NOM的决定需要仔细考虑这些高风险特征的患者中瘤再生的风险增加.
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