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在局部晚期直肠癌中,在新辅助化学放射疗法和单独化疗后的生存结果和病理完整反应与单独化疗相比

Metincan Erkaya¹, Cigdem Benlice², Bilgi Baca²

¹Cleveland Clinic, Digestive Disease and Surgery Institute, Department of Colorectal Surgery, Cleveland, OH, USA.

Surgical oncology

|June 27, 2025

概括

与局部晚期直肠癌 (LARC) 的新辅助化疗 (nCRT) 相比,单独的新辅助化疗 (nCT) 显示出相似的生存率和病理完整反应 (pCR) 率. 这支持针对特定患者亚组的选择性辐射遗漏策略.

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) 的管理正在通过全新辅助疗法 (TNT) 和降级策略发展.
目前正在探索单独的新辅助化疗 (nCT),以减少与辐射相关的毒性,同时保持瘤疗效.
对LARC进行新辅助化学放射治疗 (nCRT) 和单独使用nCT进行比较对于治疗优化至关重要.

研究的目的:

为了比较用nCRT与单独使用nCT治疗的LARC患者的整体生存率和病理完整响应 (pCR) 率.
评估LARC管理中降级策略的有效性.

主要方法:

使用2015-2019年国家癌症数据库 (NCDB) 进行的回顾性队列研究.
纳入标准:非转移性LARC患者接受了与新辅助疗法进行部分分泌切除术.
治疗权重的稳定逆概率 (IPTW) 用于平衡,使用Kaplan-Meier和Cox模型来计算生存率,并对pCR进行后勤回归.

主要成果:

在IPTW调整后,单独使用nCRT和nCT组之间总生存率 (HR:0.99,p=0.936) 或pCR率 (OR:1.20,p=0.438) 没有显著差异.
亚组分析显示,在T3节点阳性患者中,与nCRT一起的pCR更高的趋势不显著 (OR: 1.44,p=0.297).
剩余瘤边缘 (HR:3.04,p<0.001) 和不完整的病理反应 (HR:1.68,p=0.002) 是较差生存的显著预测因素.

结论:

在选择的LARC患者中,单独使用nCRT和nCT之间的可比总生存率和pCR率支持选择性辐射遗漏.
对于特定的LARC患者亚组,单独的nCT可能是一个可行的选择,与缓解升级试验的结果保持一致.
需要对生活质量和功能结果进行前性研究,以改进LARC中辐射降级患者的选择.

关键词:

化学疗法或放射疗法在IPTW工作中,局部发达的直肠癌局部发达的直肠癌没有NCDBB.新辅助化学疗法新辅助化学疗法病理学的完整反应.生存结果的结果.

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