[对新辅助疗法反应不佳的直肠癌患者的预后因素和生存分析]
1Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, Beijing100730, China.
概括
对于对新辅助疗法的反应不佳的直肠癌患者,标准治疗或巩固疗法显示了类似的生存结果. 单独的化疗-放射治疗与更糟糕的存活率有关,特别是在晚期疾病患者中.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 辐射疗法 辐射疗法
背景情况:
- 对新辅助疗法的反应不佳的直肠癌患者 (mrTRG 4或5级) 面临着具有挑战性的生存结果.
- 这一小组的最佳治疗策略仍在研究中,以改善无病和整体存活率.
研究的目的:
- 为了比较不同后新辅助疗法策略对直肠癌患者的生存影响,这些患者的反应不佳.
- 确定影响这种患者群体生存的独立因素.
主要方法:
- 对106名直肠癌患者进行了回顾性队列研究,这些患者对新辅助剂反应不佳 (mrTRG 4-5).
- 患者被分为化疗-放射治疗,巩固疗法或标准治疗组.
- 分析包括3年远程无转移存活率 (DMFS) 和整体存活率 (OS),具有多变量Cox回归.
主要成果:
- 标准治疗和巩固疗法组显示了类似的3年DMFS (74%,72%) 和OS (84%,81%),优于化疗-放射治疗组 (10%的DMFS,39%的OS).
- 单独的化疗-放射治疗是DMFS和OS差的独立风险因素. 年龄≥65也影响了OS.
- 巩固疗法没有显著改善生存率或减少并发症,但增加了与化疗相关的不良反应,并延长了手术之间的间隔.
结论:
- 对于直肠癌患者的反应不佳和不良预后特征 (局部晚期,MRF+,EMVI+),将全身疗法添加到标准的新辅助治疗中,没有生存益处.
- 在巩固疗法中延长化疗持续时间增加了不良事件,但没有改善生存结果.
- 治疗决策应该考虑在这个特定的患者群体中潜在的益处和毒性风险之间的平衡.
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