直肠癌放化疗后等待观察策略PPT课件.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 IQR19 43 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 astandardiseddefinition CCR 24 FuturePerspectives Needaprospectiverandomizedcontrolledtrialuniformstandardsforth