转变的范式:用于cT4和cn2结肠癌的新辅助化疗的利用和结果
Bennett W Hartley1, Vivi W Chen2, Punam Amin2
1Department of Surgery, Baylor College of Medicine, Houston, TX, USA. bennett.hartley@bcm.edu.
Annals of surgical oncology
|January 26, 2026
概括
手术前的新辅助化疗 (NAC) 改善了局部晚期结肠癌 (cT4) 和高结节负担 (cN2) 疾病的结果. NAC与较低的阳性边缘和淋巴结比率有关,提高了这些结肠癌患者的整体存活率.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 化疗 化疗是一种化学疗法.
背景情况:
- 前置手术切除 (USR) 是可切除结肠癌的标准.
- 局部晚期 (cT4) 和高节点负担 (cN2) 疾病存在治疗挑战.
- 新辅助化疗 (NAC) 正在作为USR的替代品或辅助品进行研究.
研究的目的:
- 为了比较NAC之后的手术和USR之后的辅助化疗 (AC) 之间的整体存活率 (OS).
- 评估NAC对cT4和cn2结肠癌边缘阳性和淋巴结比 (LNR) 的影响.
- 确定与NAC接收和患者结果相关的因素.
主要方法:
- 国家癌症数据库对非转移性,微卫星稳定的cT4或cN2结肠癌的分析.
- 用USR+AC与NAC+手术组进行比较.
- 倾向性得分匹配 (PSM) 用于操作系统分析.
- 用于共变量分析的物流回归.
主要成果:
- NAC与较低的阳性边际 (cT4: 12.5%对20.5%;cN2: 7.8%对12.5%) 和较低的LNR (cT4: 8.7%对18.7%;cN2: 17.3%对39%) 相关.
- 在cT4 (p=0.003) 和cN2疾病 (p<0.001) 中,NAC显著改善了OS.
- 在学术中心治疗的年轻,更健康的患者更有可能接受NAC.
结论:
- 在cT4和cN2结肠癌中,NAC与改善的病理结果和OS有关.
- 这些发现支持对这些晚期结肠癌阶段的NAC进行进一步的研究.
- 在某些结肠癌患者中,NAC可能会比传统的前期手术提供生存益处.
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