预先存在的腺瘤类型与直肠癌对新辅助疗法的反应之间的关联
Sameh Hany Emile1, Nir Horesh2, Zoe Garoufalia3
1Colorectal Surgery Department, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, USA; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt.
管状腺瘤相关的直肠癌对新辅助疗法 (NAT) 的反应最差,尽管在统计学上并不显著. 关键预测NAT衰竭的因素包括II期疾病,高瘤级,淋巴血管入侵,围神经入侵和CEA水平升高.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 病理学 病理学 病理学
背景情况:
- 在局部晚期直肠癌中,新辅助疗法 (NAT) 的反应受到各种因素的影响.
- 预先存在的腺瘤类型对NAT反应的影响仍未得到充分研究.
- 调查腺瘤类型可能会揭示对直肠癌治疗结果的新见解.
研究的目的:
- 为了确定先前存在的腺瘤类型和直肠癌对NAT的反应之间的关联.
- 根据腺瘤类型分析瘤特征.
- 为了确定在接受NAT的直肠癌患者中治疗失败的预测因素.
主要方法:
- 来自国家癌症数据库 (NCDB) (2004-2017) 的II-III期直肠腺癌患者的回顾性审查.
- 根据先前存在的腺瘤类型对直肠癌的分类:小腺瘤 (VA),管状腺瘤 (TA) 和管状腺瘤 (TVA).
- 病例控制分析以评估对NAT反应的失败,将腺瘤类型作为共同变量.
主要成果:
- 包括2760名患者;78.4%的患者有TVA,21.1%的VA和0.5%的TA.
- 对NAT的总体反应为55.5% (10%完整,45.5%部分).
- 与VA (46.4%) 和TVA (43.9%) (p=0.388) 相比,TA相关癌症的失败率最高 (64.3%).
- 独立预测NAT衰竭的预测因素包括II期疾病,高瘤级,淋巴血管入侵 (LVI),围神经入侵 (PNI) 和升高的预治疗CEA.
结论:
- 与管状腺瘤相关的直肠癌显示出对NAT的反应率最低,尽管这一发现没有统计学意义.
- 第二阶段的疾病,高瘤级,LVI,PNI和高预治疗CEA是NAT衰竭的重要预测因素.
- 需要进一步的研究来阐明腺瘤类型在预测治疗反应中的作用.
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