对具有完全病理缓解的直肠癌常规使用辅助化疗是否合理？
Is routine use of adjuvant chemotherapy for rectal cancer with complete pathological response justified?
作者信息
Gamaleldin Maysoon, Church James M, Stocchi Luca, Kalady Mathew, Liska David, Gorgun Emre
机构信息
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.
出版信息
Am J Surg. 2017 Mar;213(3):478-483. doi: 10.1016/j.amjsurg.2016.11.028. Epub 2016 Nov 19.
BACKGROUND
Patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiation (nCRT) can have a complete pathologic response (pCR), and are given postoperative adjuvant chemotherapy (ACT).
METHODS
A prospectively maintained outcomes database was queried for patients who had pCR to nCRT for LARC from 2000 to 2012. Local recurrence and survival were analyzed according to whether patients received ACT.
RESULTS
We identified 139 patients and excluded 9 due to lack of follow-up. Mean age was 58.9 ± 11.8 years. 83 patients (63.8%) did not receive ACT (Group A) and 47 (36.2%) did (Group B). Mean follow-up was 5.7 ± 3 and 5.6 ± 3.5 years for Groups A and B respectively (p = 0.51). Groups were comparable in age, gender, tumor differentiation, and clinical staging. There were no differences in oncological outcomes.
CONCLUSION
Avoiding routine use of ACT in patients with a pCR may be considered. Further justification of this approach warrants prospective randomized studies.
背景
接受新辅助放化疗（nCRT）的局部晚期直肠癌（LARC）患者可能会有完全病理缓解（pCR），并接受术后辅助化疗（ACT）。
方法
查询了一个前瞻性维护的结局数据库，以获取2000年至2012年期间对LARC的nCRT有pCR的患者。根据患者是否接受ACT分析局部复发和生存率。
结果
我们确定了139例患者，因缺乏随访排除9例。平均年龄为58.9±11.8岁。83例患者（63.8%）未接受ACT（A组），47例（36.2%）接受了ACT（B组）。A组和B组的平均随访时间分别为5.7±3年和5.6±3.5年（p=0.51）。两组在年龄、性别、肿瘤分化和临床分期方面具有可比性。肿瘤学结局无差异。
结论
对于有pCR的患者可考虑避免常规使用ACT。这种方法的进一步合理性需要前瞻性随机研究。
Zotero 插件