警告：新辅助治疗无反应的直肠癌 - 不要等待手术。
Word of caution: Rectal cancer without response to neoadjuvant treatment - Do not wait for surgery.
机构信息
Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.
Division of Colon and Rectal Surgery, The Ohio State University, Columbus, OH, USA.
出版信息
Am J Surg. 2023 Oct;226(4):548-552. doi: 10.1016/j.amjsurg.2023.03.021. Epub 2023 Mar 24.
BACKGROUND
We hypothesized that prolonging the interval to surgery in non-responders to neoadjuvant chemoradiation therapy (nCRT) could lead to worse oncologic outcomes.
METHODS
Rectal adenocarcinoma patients with poor tumor response to nCRT (AJCC tumor regression grade 3) were selected. Oncologic outcomes were evaluated according to the time interval between completion of nCRT and surgery.
RESULTS
Among 56 non-responders, 28 patients surgically treated ≥8 weeks after completion of nCRT had worse disease-free survival (31% vs. 49%, p = 0.05) and worse overall survival (34% vs. 53%, p = 0.02) compared to patients <8 weeks. Using the three different intervals (≥12 weeks, 6-12 weeks, and< 6 weeks), waiting longer was consistently associated with worse overall (23% vs. 48% vs. 63%, p = 0.02) and worse cancer-specific survival (35% vs. 61% vs. 71%, p = 0.04), respectively.
CONCLUSION
For rectal cancer patients who are non-responders to nCRT, delay of surgery may lead to worse oncologic outcomes.
背景
我们假设，对于新辅助放化疗（nCRT）无应答的患者，延长手术间隔时间可能导致肿瘤预后更差。
方法
选择 nCRT 后肿瘤反应不佳（AJCC 肿瘤消退分级 3）的直肠腺癌患者。根据 nCRT 完成与手术之间的时间间隔评估肿瘤学结果。
结果
在 56 名无应答者中，28 名在 nCRT 完成后≥8 周接受手术治疗的患者无疾病生存率（31%比 49%，p = 0.05）和总生存率（34%比 53%，p = 0.02）更差。使用三个不同的间隔时间（≥12 周、6-12 周和<6 周），等待时间延长与总体生存率（23%比 48%比 63%，p = 0.02）和癌症特异性生存率（35%比 61%比 71%，p = 0.04）的降低均相关。
结论
对于 nCRT 无应答的直肠癌患者，手术延迟可能导致肿瘤学结果更差。
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