Zhang X Y, Lu Q Y, Sun Y S
Department of Radiology, Peking University Cancer Hospital & Institute, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Bejing 100142, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Mar 25;23(3):243-247. doi: 10.3760/cma.j.cn.441530-20200224-00078.
After neoadjuvant chemoradiotherapy(nCRT), 15%-40% of rectal cnacers has a pathological complete response (pCR), with non-malignant cells demonstrated in histological assessment of the surgical resection specimen. Since these patients have excellent oncological outcomes, there has been a rapidly growing interest in organ preservation for those who achieve a clinical complete response (cCR), that is "Watch and Wait strategy" (W&W). One of the major challenges in the W&W of rectal cancer is the careful and precise selection of patients suitable for this approach. The published series on W&W has all used different modalities to assess response post nCRT, including the MSKCC's three-tiered evaluation plan and Mercury's mrTRG criteria. Except significant heterogeneous results, the evidence available comes mostly from retrospective cohort studies, furthermore, there is a lack of data of long-term outcomes. How to accurately screen pCR patients preoperatively is an important and difficult issue of clinical concern.
新辅助放化疗（nCRT）后，15%-40%的直肠癌患者会出现病理完全缓解（pCR），手术切除标本的组织学评估显示为无恶性细胞。由于这些患者具有良好的肿瘤学预后，对于达到临床完全缓解（cCR）的患者，即“观察等待策略”（W&W），人们对器官保留的兴趣迅速增长。直肠癌W&W的主要挑战之一是仔细且精确地选择适合这种方法的患者。已发表的关于W&W的系列研究都使用了不同的方式来评估nCRT后的反应，包括纪念斯隆凯特琳癌症中心（MSKCC）的三级评估计划和水星（Mercury）的磁共振成像肿瘤反应分级（mrTRG）标准。除了显著的异质性结果外，现有证据大多来自回顾性队列研究，此外，缺乏长期预后的数据。如何在术前准确筛选出pCR患者是临床关注的一个重要且困难的问题。
