Li Jun, Li Lunjin, Yang Lin, Yuan Jiatian, Lv Bo, Yao Yanan, Xing Shasha
General Surgery Department and Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
Pharmacy Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China.
Oncotarget. 2016 Jul 12;7(28):44857-44870. doi: 10.18632/oncotarget.8622.
Wait-and-see treatment strategies may benefit rectal cancer patients who achieve a clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). In this study, we analyzed data from 9 eligible trials to compare the oncologic outcomes of 251 rectal cancer patients achieving a cCR through nonsurgical management approaches with the outcomes of 344 patients achieving a pathologic complete response (pCR) through radical surgery. The two patient groups did not differ in distant metastasis rates or disease-free and overall survival, but the nonsurgical group had a higher risk of 1, 2, 3, and 5-year local recurrence. Hence, we concluded that for rectal cancer patients achieving a cCR after NCRT, a wait-and-see strategy with strict selection criteria, an appropriate follow-up schedule, and salvage treatments achieved outcomes at least as good as radical surgery. Long-term randomized and controlled trials with more uniform inclusion criteria and standardized follow-up schedules will help clarify the risks and benefits of wait-and-see treatment strategies for these patients.
观察等待治疗策略可能使新辅助放化疗（NCRT）后达到临床完全缓解（cCR）的直肠癌患者受益。在本研究中，我们分析了9项符合条件的试验数据，以比较251例通过非手术管理方法达到cCR的直肠癌患者与344例通过根治性手术达到病理完全缓解（pCR）的患者的肿瘤学结局。两组患者的远处转移率、无病生存率和总生存率无差异，但非手术组1年、2年、3年和5年局部复发风险更高。因此，我们得出结论，对于NCRT后达到cCR的直肠癌患者，采用严格选择标准、适当随访计划和挽救治疗的观察等待策略可取得至少与根治性手术一样好的结局。纳入标准更统一、随访计划更标准化的长期随机对照试验将有助于阐明这些患者观察等待治疗策略的风险和益处。
