2022年医学专题—直肠癌放化疗后等待观察策略.ppt

Watch-and-waitapproachversussurgicalresectionafterchemoradiotherapyforpatientswithrectalcancer(theOnCoReproject):apropensity-scorematchedcohortanalysisLancetOncolPublishedOnlineDecember16,2015第一页，共二十六页。v2004.10,AnnalsofSurgery,Habr-Gama.egv265patientswithdistalrectalweretreatedbyCRTwith5-FU,Leucovorinand5040cGyvFive-yearOSandDFSrateswere88%and83%inResectionGroup,100%and92%inObservationGroup第二页，共二十六页。Purposevoncologicaloutcomesbetweenwatchandwaitandsurgicalresectionvthesafetyofthewatch-and-wait第三页，共二十六页。ThedefinitionofacCRv(1)substantialdownsizingwithnoresidualtumororresidualfibrosisonlyv(2)nosuspiciouslymphnodesonMRIv(3)noresidualtumoratendoscopyoronlyasmallresidualerythematousulcerorscarv(4)negativebiopsiesfromthescar,ulcer,orformertumorlocationv(5)nopalpabletumor,wheninitiallypalpablewithdigitalrectalexamination第四页，共二十六页。Methodsvone-to-onepairedcohortsofwatchandwaitversussurgicalresectionusingpropensity-scorematching（Tstage,age,andperformancestatus）vprimaryendpointwasDFSvsecondaryendpointswasOSandcolostomy-freesurvival第五页，共二十六页。MethodsvCCRstandard:after CRT 8 weeks or morevabsence of residual ulceration,stenosis,or mass within the rectum during digital rectal examination and endoscopic examination第六页，共二十六页。Methodsv259patientsfromatertiarycancercentreinManchester,UKbetweenJan14,2011andApril15,2013vCCR-wait-and-seepolicygroup(31)vNCCR-surgicalresection(228)第七页，共二十六页。MethodsvthreeneighbouringUKregionalcancercentres(LancashireandSouthCumbria,MerseysideandCheshire,andnorthWales)March10,2005,andJan21,2015-wait-and-seepolicygroup(98)第八页，共二十六页。Methodsvpreoperativechemoradiotherapy:45Gyin25dailyfractionswithconcurrentfluoropyrimidine-basedchemotherapyfor34days第九页，共二十六页。MethodsvDatainclude:vTandNstages(MRI)vSex,age,BMIvSmokingstatus,performancestatusvBaselineCEAvHistologicalgradevHeightfromanalverge第十页，共二十六页。MethodsvStatisticalanalysisvcontinuousvariables-Kruskal-WallisandWilcoxonsigned-ranktestsvcategoricalvariables-andMcNamaratestsvPvalue第十一页，共二十六页。第十二页，共二十六页。第十三页，共二十六页。第十四页，共二十六页。ResultsvMedianfollow-upof33months(IQR1943)v44/129patientshadlocalregrowths(42patientshadmucosallesions,2patienthadsubmucosalormesorectallesions)第十五页，共二十六页。Results第十六页，共二十六页。Resultsv31underwentsubsequentsalvagesurgeryTandNstages5ypT1,10ypT2,16ypT324ypN0,6ypN1,1ypN2第十七页，共二十六页。Results第十八页，共二十六页。Results第十九页，共二十六页。Results第二十页，共二十六页。Discussionvanewoncologicalendpoint-non-regrowthdisease-freesurvivalvthefirsttime-colostomy-freesurvival(1/4CCRavoidcolostomy)第二十一页，共二十六页。DiscussionvTwoadditionalfindingvabout2/3nodepositiveassessedbyMRI,butdidnotaffectsubsequentendpointsv9%(CCR)didnotreceivepreoperativechemotherapyanditsabsencedidnotaffectstudyendpoints第二十二页，共二十六页。Discussionvlimitations1.follow-upwasrelativelyshort2.notrepresentativeofreal-worldoff-trialclinicalpractice3.isariskinpatientswithCCRmanagedbywatchandwait第二十三页，共二十六页。DiscussionvStrengths1.largestreportedcohortoutside2.fromseveraltreatmentcentres3.astandardiseddefinitionCCR第二十四页，共二十六页。FuturePerspectivesvNeedaprospectiverandomizedcontrolledtrialvuniformstandardsforthedefinitionofacCRvTheproposedselectioncriteriaandfollow-upcanbeusedinfuturetrialsaimedatprovidingmoreevidenceonthewait-and-seepolicy第二十五页，共二十六页。内容(nirng)总结Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer(the OnCoRe project):a propensity-score matched cohort analysis。Sex,age,BMI第二十六页，共二十六页。