直肠癌放化疗后等待观察策略.pptxVIP

直肠癌放化疗后等待观察策略第1页/共26页 2004.10 ,Annals of Surgery,Habr-Gama.eg265 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第2页/共26页 Purposeoncological outcomes between watch and wait and surgical resection the safety of the watch-and-wait 第3页/共26页 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 第4页/共26页 Methodsone-to-one paired cohorts of watch and wait versus surgical resection using propensity-score matching（ T stage, age, and performance status）primary endpoint was DFSsecondary endpoints was OS and colostomy-free survival第5页/共26页 MethodsCCR standard: after CRT 8 weeks or moreabsence of residual ulceration, stenosis, or mass within the rectum during digital rectal examination and endoscopic examination第6页/共26页 Methods259 patients from a tertiary cancer centre in Manchester, UK between Jan 14, 2011 and April 15, 2013CCR--wait-and-see policy group(31)NCCR--surgical resection(228)第7页/共26页 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)第8页/共26页 Methods preoperative chemoradiotherapy:45 Gy in 25 daily fractions with concurrent fluoropyrimidine-based chemotherapy for 34 days第9页/共26页 MethodsData include: T and N stages (MRI) Sex, age, BMI Smoking status, performance status Baseline CEA Histological grade Height from anal verge第10页/共26页 MethodsStatistical analysiscontinuous variables--Kruskal-Wallis and Wilcoxon signed-rank testscategorical variables--χ2 and McNamara testsP value第