Dai Dianyin, Liu Ge, Liu Huanran, Liu Yanfeng, Liu Xinlu, Li Shuang, Lei Yanan, Gao Yun, Wang Yuezhu, Zhang Shoujia, Zhang Ran
Department of Anorectal Surgery, Department of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Surg. 2023 Jan 16;9:1006624. doi: 10.3389/fsurg.2022.1006624. eCollection 2022.
In recent years, total neoadjuvant therapy (TNT) has emerged as a new therapeutic strategy against advanced rectal cancer (RC). After administration of TNT, some patients show complete clinical response (cCR) to treatment however, disputes about the effects of TNT and the alternative treatment plans in case of recurrence after cCR still exist.
A total of 100 patients were included in this paper. CR and non-CR was observed when these patients were administered with TNT at the First Affiliated Hospital of Dalian Medical University, China from May 2015 to June 2021. These patients received different chemotherapeutic regimens, with close monitoring and watch and wait (W&W) strategy being applied by a multidisciplinary team (MDT). According to treatment results, patients were divided into a cCR group and a non-cCR group; according to the recurrence during W&W, they were divided into a recurrence group and a no-local-recurrence group. This study analyzed the factors that may affect the prognosis, and summarized the surgery and treatment after recurrence.
The TNT strategy was effective, and 85% of patients achieved local remission. However, W&W did not affect the survival time of CR patients, nor did it cause new distant metastasis due to local recurrence during the observation period (> 0.05). However, for patients with positive CRM, we do not recommend W&W as the first choice of treatment (< 0.05).
(1) Whole-course neoadjuvant therapy was an effective treatment scheme for advanced mid-term rectal cancer. The total local reduction rate of this group of cases was 85.00%, meaning that 25 patients achieved CR. (2) W&W was safe and reliable, and CR patients could receive it as the preferred treatment. (3) CRM was an independent risk factor for local recurrence in CR patients. We do not recommend W&W as the preferred treatment for CR patients with positive CRM.
近年来，全新辅助治疗（TNT）已成为针对晚期直肠癌（RC）的一种新治疗策略。在进行TNT治疗后，部分患者对治疗呈现完全临床缓解（cCR），然而，关于TNT的疗效以及cCR后复发情况下的替代治疗方案仍存在争议。
本文共纳入100例患者。2015年5月至2021年6月期间，这些患者在中国大连医科大学附属第一医院接受TNT治疗时观察其CR和非CR情况。这些患者接受了不同的化疗方案，多学科团队（MDT）采用密切监测和观察等待（W&W）策略。根据治疗结果，将患者分为cCR组和非cCR组；根据观察等待期间的复发情况，分为复发组和无局部复发组。本研究分析了可能影响预后的因素，并总结了复发后的手术及治疗情况。
TNT策略有效，85%的患者实现局部缓解。然而，观察等待并未影响CR患者的生存时间，在观察期内也未因局部复发导致新的远处转移（>0.05）。然而，对于环周切缘阳性的患者，我们不建议将观察等待作为首选治疗方案（<0.05）。
（1）全程新辅助治疗是晚期中期直肠癌的有效治疗方案。该组病例的总局部缓解率为85.00%，即25例患者实现CR。（2）观察等待安全可靠，CR患者可将其作为首选治疗。（3）环周切缘是CR患者局部复发的独立危险因素。对于环周切缘阳性的CR患者，我们不建议将观察等待作为首选治疗方案。
