直肠癌放化疗后等待观察策略.pptVIP

Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis Lancet Oncol Published Online December 16, 2015 2004.10 ,Annals of Surgery,Habr-Gama.eg 265 patients with distal rectal were treated by CRT with 5-FU, Leucovorin and 5040 cGy Five-year OS and DFS rates were 88% and 83% in Resection Group ,100% and 92% in Observation Group Purpose oncological outcomes between watch and wait and surgical resection the safety of the watch-and-wait The definition of a cCR (1) substantial downsizing with no residual tumor or residual fibrosis only (2) no suspicious lymph nodes on MRI (3) no residual tumor at endoscopy or only a small residual erythematous ulcer or scar (4) negative biopsies from the scar, ulcer, or former tumor location (5) no palpable tumor, when initially palpable with digital rectal examination Methods one-to-one paired cohorts of watch and wait versus surgical resection using propensity-score matching（ T stage, age, and performance status） primary endpoint was DFS secondary endpoints was OS and colostomy-free survival Methods CCR standard: after CRT 8 weeks or more absence of residual ulceration, stenosis, or mass within the rectum during digital rectal examination and endoscopic examination Methods 259 patients from a tertiary cancer centre in Manchester, UK between Jan 14, 2011 and April 15, 2013 CCR--wait-and-see policy group(31) NCCR--surgical resection(228) Methods three neighbouring UK regional cancer centres(Lancashire and South Cumbria, Merseyside and Cheshire, and north Wales) March 10, 2005, and Jan 21, 2015-- wait-and-see policy group(98) Methods preoperative chemoradiotherapy:45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy for 34 days Methods Data include: T and N stages (MRI) Sex, age, BMI Smoking status, performance status Baseline CEA Histological grade Height from a