在现实环境中针对局部晚期直肠癌的新辅助疗法后,病理完整反应:基于人口的研究
Lina Cadili1, Jonathan M Loree2, Michael Peacock3
1Division of General Surgery, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Frontiers in oncology
|June 16, 2025
概括
对于局部发达的直肠癌,延迟长期化学放射治疗 (LCRT) 后的手术增加了完整的病理反应 (pCR) 率. 然而,获得的总体pCR低于临床试验中的水平.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 辐射瘤学 辐射瘤学
背景情况:
- 新辅助疗法 (NAT) 对局部晚期直肠癌至关重要,旨在减少局部复发并改善结果.
- 虽然一些患者在NAT后达到完整的病理反应 (pCR),但NAT和手术之间的最佳时间来最大限度地提高这种反应尚未确定.
研究的目的:
- 研究新辅助疗法 (NAT) 和手术之间的时间间隔对直肠癌患者的pCR率的影响.
- 为了确定与pCR和不同新辅助治疗方案后的存活率相关的因素.
主要方法:
- 在2000年至2017年期间接受治疗的3476名局部晚期直肠癌 (Tany,Nany,M0) 的成年患者的回顾性分析.
- 患者接受了短期放射疗法 (SCRT) 或长期化疗放射疗法 (LCRT),随后进行全腹腔切除.
- 使用多变量逻辑回归分析了治疗时间,患者特征,pCR和生存率之间的关联.
主要成果:
- 在LCRT (13.2%) 后,与SCRT (1.5%) 相比,pCR率显著更高.
- 对于SCRT,pCR与手术,瘤等级和阶段的较长间隔积极相关.
- 对于LCRT,pCR与手术前的时间无关,但与性别和阶段有关. 在LCRT后6-10周的间隔与更高的5年整体存活率 (69.8%) 相关.
结论:
- 在以人口为基础的队列中,在LCRT后更长的激素切除延迟与增加的PCR率有关.
- 在这项研究中观察到的总体pCR率低于临床试验群体中报告的,这表明患者选择或治疗方案的潜在差异.
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