（参考课件）直肠癌放化疗后等待观察策略.ppt

Watch-and-waitapproachversussurgicalresectionafterchemoradiotherapyforpatientswithrectalcancer(theOnCoReproject):apropensity-scorematchedcohortanalysis,LancetOncolPublishedOnlineDecember16,2015,1,2004.10,AnnalsofSurgery,Habr-Gama.eg265patientswithdistalrectalweretreatedbyCRTwith5-FU,Leucovorinand5040cGyFive-yearOSandDFSrateswere88%and83%inResectionGroup,100%and92%inObservationGroup,2,Purpose,oncologicaloutcomesbetweenwatchandwaitandsurgicalresectionthesafetyofthewatch-and-wait,3,ThedefinitionofacCR,(1)substantialdownsizingwithnoresidualtumororresidualfibrosisonly(2)nosuspiciouslymphnodesonMRI(3)noresidualtumoratendoscopyoronlyasmallresidualerythematousulcerorscar(4)negativebiopsiesfromthescar,ulcer,orformertumorlocation(5)nopalpabletumor,wheninitiallypalpablewithdigitalrectalexamination,4,Methods,one-to-onepairedcohortsofwatchandwaitversussurgicalresectionusingpropensity-scorematching（Tstage,age,andperformancestatus）primaryendpointwasDFSsecondaryendpointswasOSandcolostomy-freesurvival,5,Methods,CCRstandard:afterCRT8weeksormoreabsenceofresidualulceration,stenosis,ormasswithintherectumduringdigitalrectalexaminationandendoscopicexamination,6,Methods,259patientsfromatertiarycancercentreinManchester,UKbetweenJan14,2011andApril15,2013CCR-wait-and-seepolicygroup(31)NCCR-surgicalresection(228),7,Methods,threeneighbouringUKregionalcancercentres(LancashireandSouthCumbria,MerseysideandCheshire,andnorthWales)March10,2005,andJan21,2015-wait-and-seepolicygroup(98),8,Methods,preoperativechemoradiotherapy:45Gyin25dailyfractionswithconcurrentfluoropyrimidine-basedchemotherapyfor34days,9,Methods,Datainclude:TandNstages(MRI)Sex,age,BMISmokingstatus,performancestatusBaselineCEAHistologicalgradeHeightfromanalverge,10,Methods,Statisticalanalysiscontinuousvariables-Kruskal-WallisandWilcoxonsigned-ranktestscategoricalvariables-andMcNamaratestsPvalue,11,12,13,14,Results,Medianfollow-upof33months(IQR1943)44/129patientshadlocalregrowths(42patientshadmucosallesions,2patienthadsubmucosalormesorectallesions),15,Results,16,Results,31underwentsubsequentsalvagesurgeryTandNstages5ypT1,10ypT2,16ypT324ypN0,6ypN1,1ypN2,17,Results,18,Results,19,Results,20,Discussion,anewoncologicalendpoint-non-regrowthdisease-freesurvivalthefirsttime-colostomy-freesurvival(1/4CCRavoidcolostomy),21,Discussion,Twoadditionalfindingabout2/3nodepositiveassessedbyMRI,butdidnotaffectsubsequentendpoints9%(CCR)didnotreceivepreoperativechemotherapyanditsabsencedidnotaffectstudyendpoints,22,Discussion,limitations1.follow-upwasrelativelyshort2.notrepresentativeofreal-worldoff-trialclinicalpractice3.isariskinpatientswithCCRmanagedbywatchandwait,23,Discussion,Strengths1.largestreportedcohortoutside2.fromseveraltreatmentcentres3.astandardiseddefinitionCCR,24,FuturePerspectives,Needaprospectiverandomizedcontrolledtrialuniformst