结肠癌治愈的定义:对15项随机临床试验的综合分析
Alessandro Pastorino1, Heshan Liu2, Levi Pederson2
1IRCCS Ospedale Policlinico San Martino, Medical Oncology Unit 1, Genova, Italy.
JAMA oncology
|October 2, 2025
概括
在6年后,复发风险低于0.5%表明可以治愈II至III期结肠癌 (CC). 这一发现有助于患者沟通和结肠癌幸存者的后续策略.
科学领域:
- 在瘤学瘤学.
- 临床试验 临床试验
- 癌症研究 癌症研究
背景情况:
- 在第二到第三阶段结肠癌 (CC) 中确定治愈是具有挑战性的,因为传统终点的局限性,如死亡和第二原发性瘤.
- 这些局限性使得CC患者的长期结果的准确沟通复杂化.
研究的目的:
- 为了区分真正的CC复发与手术后竞争的健康事件.
- 为了确定真正的CC复发的发生率接近0%以确定治愈.
主要方法:
- 从15个第三阶段随机临床试验 (ACCENT和IDEA数据库) 的个体患者数据的聚合分析.
- 卡普兰-梅尔和阿伦-约翰森方法评估了CC相关复发的时间,将死亡和第二次原发性瘤视为竞争风险.
- 考克斯回归模型分析了根据性别,阶段和瘤分层的预后关联,包括接受辅助化疗的患者.
主要成果:
- 到第10年,复发风险下降到0.5%以下,并且仍然低于这一门,支持治疗的实际定义.
- 竞争事件分析表明,死亡和第二次原发性瘤增加了明显的复发率,特别是在老年患者中.
- 当死亡被认为是竞争风险时,女性患者的复发累积发病率较低 (HR,0.58;95% CI,0.45-0.76).
结论:
- 在手术后6年,复发率低于0.5%支持对第二到第三阶段结肠癌治愈的实际定义.
- 识别这种治疗里程碑可以提高患者与医生的关于预后的沟通.
- 这种定义还可以为优化后续持续时间提供信息,并减少对长期,可能不必要的长期监测的需求.
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