针对局部晚期直肠癌接受新辅助化疗和手术的老年患者的教科书瘤结局:多中心研究
Alessandra Pulvirenti1,2, Carlotta Parati3,4, Simona Deidda5
1Department of Surgical, Oncological and Gastroenterological Sciences (DiSCOG), University of Padua, Via Giustiniani 2, 35010, Padua, Italy. alessandra.pulvirenti@unipd.it.
Updates in surgery
|August 24, 2025
概括
在接受局部晚期直肠癌 (LARC) 低前切除 (LAR) 的老年患者中,在接受新辅助化疗 (nCRT) 后,达到了教科书的瘤结局 (TOO). 这证明了老年人多模式治疗的可行性.
科学领域:
- 癌症学
- 外科瘤学
- 老年医学
背景情况:
- 局部晚期直肠癌 (LARC) 的标准治疗包括新辅助化疗 (nCRT),其次是全侧直肠切除 (TME).
- 老年患者 (≥70岁) 可能会因为并发症和虚弱而面临这种标准方法的挑战.
- 教科书瘤结果 (TOO) 是外科瘤学的综合质量指标.
研究的目的:
- 在接受低前切除 (LAR) 的老年患者 (≥70岁) 中评估TOO的发生率.
- 在这个患者群体中确定 TOO 的预测因素.
主要方法:
- 在意大利三个中心对157名老年LARC患者进行了追溯分析,在2011年至2023年期间接受了nCRT治疗,随后进行了LAR治疗.
- 被定义为达到R0切除,没有长时间住院 (<11天),没有重大并发症 (Clavien- Dindo <3b),没有30天的再入院,没有90天的死亡率.
主要成果:
- 在61%的患者中实现了TOO.
- 长时间住院是最常见的限制因素 (70.7%),其次是30天的再入院 (87%).
- 没有重大并发症 (91%),R0切除 (98%) 和90天死亡率 (100%) 的高率.
- 下 (y) pTNM阶段是TOO的唯一显著预测因素 (p=0. 008).
结论:
- 大部分老年患者在接受nCRT和LARC后达到TOO.
- 在老年人群中,多模式治疗方法是可行的和有效的.
- 进一步的研究可能将重点放在优化护理途径,以减少这一群体的住院和再入院.
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