局部进展期直肠癌新辅助治疗后临床与病理反应的长期肿瘤学结果分析。
Analysis of long-term oncological results of clinical versus pathological responses after neoadjuvant treatment in locally advanced rectal cancer.
机构信息
Colorectal Surgery Unit, Gastroenterology Hospital, Dr. Carlos Bonorino Udaondo, Av. Caseros 2061, 1264, Ciudad Autónoma de Buenos Aires (CABA), Argentina.
Imaxe Image Diagnosis Center, Ciudad Autónoma de Buenos Aires (CABA), Argentina.
出版信息
World J Surg Oncol. 2020 Nov 30;18(1):313. doi: 10.1186/s12957-020-02094-1.
BACKGROUND
Nonoperative management after neoadjuvant treatment in low rectal cancer enables organ preservation and avoids surgical morbidity. Our aim is to compare oncological outcomes in patients with clinical complete response in watch and wait strategy with those who received neoadjuvant therapy followed by surgery with a pathological complete response.
METHODS
Patients with non-metastatic rectal cancer after neoadjuvant treatment with clinical complete response in watch and wait approach (group 1, n = 26) and complete pathological responders (ypT0N0) after chemoradiotherapy and surgery (group 2, n = 22), between January 2011 and October 2018, were included retrospectively, and all of them evaluated and followed in a multidisciplinary team. A comparative analysis of local and distant recurrence rates and disease-free and overall survival between both groups was carried out. Statistical analysis was performed using log-rank test, Cox proportional hazards regression model, and Kaplan-Meier curves.
RESULTS
No differences were found between patient's demographic characteristics in both groups. Group 1: distance from the anal verge mean 5 cm (r = 1-12), 10 (38%) stage III, and 7 (27%) circumferential resection margin involved. The median follow-up of 47 months (r = 6, a 108). Group 2: distance from the anal verge mean 7 cm (r = 2-12), 16 (72%) stage III, and 13 (59%) circumferential resection margin involved. The median follow-up 49.5 months (r = 3, a 112). Local recurrence: 2 patients in group 1 (8.3%) and 1 in group 2 (4.8%) (p = 0.6235). Distant recurrence: 1 patient in group 1 (3.8%) and 3 in group 2 (19.2%) (p = 0.2237). Disease-free survival: 87.9% in group 1, 80% in group 2 (p = 0.7546). Overall survival: 86% in group 1 and 85% in group 2 (p = 0.5367).
CONCLUSION
Oncological results in operated patients with pathological complete response were similar to those in patients under a watch and wait strategy mediating a systematic and personalized evaluation. Surgery can safely be deferred in clinical complete responders.
背景
新辅助治疗后低位直肠癌的非手术治疗可保留器官并避免手术发病率。我们的目的是比较临床完全缓解的患者在观察等待策略中的肿瘤学结果与接受新辅助治疗后手术且病理完全缓解的患者。
方法
回顾性纳入 2011 年 1 月至 2018 年 10 月期间新辅助治疗后临床完全缓解的非转移性直肠癌患者（观察组 1，n=26）和接受放化疗及手术的完全病理缓解者（ypT0N0，观察组 2，n=22），并在多学科团队中对所有患者进行评估和随访。对两组患者的局部和远处复发率、无病生存率和总生存率进行了比较分析。采用对数秩检验、Cox 比例风险回归模型和 Kaplan-Meier 曲线进行统计学分析。
结果
两组患者的人口统计学特征无差异。观察组 1：肛缘距离平均 5cm（r=1-12），10 例（38%）为 III 期，7 例（27%）累及环周切缘。中位随访时间为 47 个月（r=6，a 108）。观察组 2：肛缘距离平均 7cm（r=2-12），16 例（72%）为 III 期，13 例（59%）累及环周切缘。中位随访时间为 49.5 个月（r=3，a 112）。局部复发：观察组 1 中有 2 例（8.3%），观察组 2 中有 1 例（4.8%）（p=0.6235）。远处复发：观察组 1 中有 1 例（3.8%），观察组 2 中有 3 例（19.2%）（p=0.2237）。无病生存率：观察组 1 为 87.9%，观察组 2 为 80%（p=0.7546）。总生存率：观察组 1 为 86%，观察组 2 为 85%（p=0.5367）。
结论
手术病理完全缓解患者的肿瘤学结果与接受系统性和个体化评估的观察等待策略患者相似。在临床完全缓解的患者中，可以安全地推迟手术。
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