直肠癌放化疗后等待观察策略

Watch-and-waitapproachversussurgicalresectionafterchemoradiotherapyforpatientswithrectalcancer(theOnCoReproject):apropensity-scorematchedcohortanalysisLancetOncolPublishedOnlineDecember16,2015第一页，共二十六页。整理课件2004.10,AnnalsofSurgery,Habr-Gama.eg265patientswithdistalrectalweretreatedbyCRTwith5-FU,Leucovorinand5040cGyFive-yearOSandDFSrateswere88%and83%inResectionGroup,100%and92%inObservationGroup第二页，共二十六页。整理课件Purposeoncologicaloutcomesbetweenwatchandwaitandsurgicalresectionthesafetyofthewatch-and-wait第三页，共二十六页。整理课件ThedefinitionofacCR(1)substantialdownsizingwithnoresidualtumororresidualfibrosisonly(2)nosuspiciouslymphnodesonMRI(3)noresidualtumoratendoscopyoronlyasmallresidualerythematousulcerorscar(4)negativebiopsiesfromthescar,ulcer,orformertumorlocation(5)nopalpabletumor,wheninitiallypalpablewithdigitalrectalexamination第四页，共二十六页。整理课件Methodsone-to-onepairedcohortsofwatchandwaitversussurgicalresectionusingpropensity-scorematching（Tstage,age,andperformancestatus）primaryendpointwasDFSsecondaryendpointswasOSandcolostomy-freesurvival第五页，共二十六页。整理课件MethodsCCRstandard:afterCRT8weeksormoreabsenceofresidualulceration,stenosis,ormasswithintherectumduringdigitalrectalexaminationandendoscopicexamination第六页，共二十六页。整理课件Methods259patientsfromatertiarycancercentreinManchester,UKbetweenJan14,2011andApril15,2013CCR--wait-and-seepolicygroup(31)NCCR--surgicalresection(228)第七页，共二十六页。整理课件MethodsthreeneighbouringUKregionalcancercentres(LancashireandSouthCumbria,MerseysideandCheshire,andnorthWales)March10,2005,andJan21,2015--wait-and-seepolicygroup(98)第八页，共二十六页。整理课件Methodspreoperativechemoradiotherapy:45Gyin25dailyfractionswithconcurrentfluoropyrimidine-basedchemotherapyfor34days第九页，共二十六页。整理课件MethodsDatainclude:TandNstages(MRI)Sex,age,BMISmokingstatus,performancestatusBaselineCEAHistologicalgradeHeightfromanalverge第十页，共二十六页。整理课件MethodsStatisticalanalysiscontinuousvariables--Kruskal-WallisandWilcoxonsigned-ranktestscategoricalvariables--χ²andMcNamaratestsPvalue第十一页，共二十六页。整理课件第十二页，共二十六页。整理课件第十三页，共二十六页。整理课件第十四页，共二十六页。整理课件ResultsMedianfollow-upof33months(IQR19–43)44/129patientshadlocalregrowths(42patientshadmucosallesions,2patienthadsubmucosalormesorectallesions)第十五页，共二十六页。整理课件Results第十六页，共二十六页。整理课件Results31underwentsubsequentsalvagesurgeryTandNstages5ypT1,10ypT2,16ypT324ypN0,6ypN1,1ypN2第十七页，共二十六页。整理课件Results第十八页，共二十六页。整理课件Results第十九页，共二十六页。整理课件Results第二十页，共二十六页。整理课件Discussionanewoncologicalendpoint--non-regrowthdisease-freesurvivalthefirsttime--colostomy-freesurvival(1/4CCRavoidcolostomy)第二十一页，共二十六页。整理课件DiscussionTwoadditionalfindingabout2/3nodepositiveassessedbyMRI,butdidnotaffectsubsequentendpoints9%(CCR)didnotreceivepreoperativechemotherapyanditsabsencedidnotaffectstudyendpoints第二十二页，共二十六页。整理课件Discussionlimitations1.follow-upwasrelativelyshort2.notrepresentativeofreal-worldoff-trialclinicalpractice3.isariskinpatientswithCCRmanagedbywatchandwait第二十三页，共二十六页。整理课件DiscussionStrengths1.largestreportedcohortoutside2.fromseveraltreatmentcentres3.astandardiseddefinition—CCR

第二十四页，共二十六页。整理课件FuturePerspectivesNeedaprospectiverandomizedcontrolledtrialuniform

standardsforthedefinitionofacCRTheproposedselectioncriteriaandfollow-upcanbeusedinfuturetrialsaimedatprovidingmoreevidenceonthewait-and-seepolicy第二十五页，共二十六页。整理课件内容(nèiróng)总结