• “中国科技期刊卓越行动计划”中文领军期刊
  • 百种中国杰出学术期刊
  • 中国百强报刊
  • RCCSE中国核心学术期刊(A+)
  • 中国自然科学类核心期刊
  • 中国高校百佳科技期刊
  • 中国精品科技期刊
  • 中国科技论文统计源期刊
  • 中华医学会优秀期刊
  • 中国精品科技期刊顶尖学术论文(5000)项目来源期刊
  • 入选中国高质量科技期刊分级目录(消化病学)T1级
  • 入选《中国学术期刊影响因子年报(自然科学与工程技术)》Q1区
  • 入选《科技期刊世界影响力指数(WJCI)报告(2022)》
  • “中国科技期刊卓越行动计划”中文领军期刊
  • 百种中国杰出学术期刊
  • 中国百强报刊
  • RCCSE中国核心学术期刊(A+)
  • 中国自然科学类核心期刊
  • 中国高校百佳科技期刊
  • 中国精品科技期刊
  • 中国科技论文统计源期刊
  • 中华医学会优秀期刊
  • 中国精品科技期刊顶尖学术论文(5000)项目来源期刊
  • 入选中国高质量科技期刊分级目录(消化病学)T1级
  • 入选《中国学术期刊影响因子年报(自然科学与工程技术)》Q1区
  • 入选《科技期刊世界影响力指数(WJCI)报告(2022)》

直肠癌新辅助治疗后近临床完全缓解患者行等待观察策略的预后及肿瘤复发影响因素分析

任晓东, 胡震, 李耀平, 侯生槐, 王若雅, 李二峰

任晓东, 胡震, 李耀平, 等. 直肠癌新辅助治疗后近临床完全缓解患者行等待观察策略的预后及肿瘤复发影响因素分析[J]. 中华消化外科杂志, 2024, 23(12): 1518-1523. DOI: 10.3760/cma.j.cn115610-20241124-00503
引用本文: 任晓东, 胡震, 李耀平, 等. 直肠癌新辅助治疗后近临床完全缓解患者行等待观察策略的预后及肿瘤复发影响因素分析[J]. 中华消化外科杂志, 2024, 23(12): 1518-1523. DOI: 10.3760/cma.j.cn115610-20241124-00503
Ren Xiaodong, Hu Zhen, Li Yaoping, et al. Prognosis of rectal cancer patients with wait and see strategy after near clinical complete res-ponse to neoadjuvant therapy and analysis of influencing factors for tumor recurrence[J]. Chinese Journal of Digestive Surgery, 2024, 23(12): 1518-1523. DOI: 10.3760/cma.j.cn115610-20241124-00503
Citation: Ren Xiaodong, Hu Zhen, Li Yaoping, et al. Prognosis of rectal cancer patients with wait and see strategy after near clinical complete res-ponse to neoadjuvant therapy and analysis of influencing factors for tumor recurrence[J]. Chinese Journal of Digestive Surgery, 2024, 23(12): 1518-1523. DOI: 10.3760/cma.j.cn115610-20241124-00503

直肠癌新辅助治疗后近临床完全缓解患者行等待观察策略的预后及肿瘤复发影响因素分析

基金项目: 

山西省自然科学基金 202103021224379

详细信息
    通讯作者:

    李耀平,Email:renxiaodong0120@163.com

Prognosis of rectal cancer patients with wait and see strategy after near clinical complete res-ponse to neoadjuvant therapy and analysis of influencing factors for tumor recurrence

Funds: 

Shanxi Provincial Natural Science Foundation 202103021224379

More Information
  • 摘要:
    目的 

    探讨直肠癌新辅助治疗后近临床完全缓解(near‑cCR)患者行等待观察策略的预后及肿瘤复发的影响因素。

    方法 

    采用回顾性队列研究方法。收集2013年1月至2017年12月收治的463例(山西省人民医院89例、山西省肿瘤医院374例)低位进展期直肠癌行新辅助治疗患者的临床病理资料;男258例,女205例;年龄为(62±7)岁。患者新辅助治疗后6周接受疗效评估,行等待观察策略的near‑cCR患者全面复查后追加辅助化疗6个疗程。观察指标:(1)新辅助治疗情况。(2)影响直肠癌新辅助治疗达到near‑cCR行等待观察策略患者肿瘤复发的因素。(3)预后分析。正态分布的计量资料组间比较采用独立样本t检验。计数资料组间比较采用χ²检验。等级资料比较采用非参数秩和检验。采用Kaplan‑Meier法绘制生存曲线,log‑rank检验进行生存分析。多因素分析采用二元logsitic回归模型。

    结果 

    (1)新辅助治疗情况。新辅助治疗后达到near‑cCR患者136例,其中86例行等待观察策略,50例行腹腔镜直肠癌根治术。86例行等待观察策略患者中,临床分期Ⅱ期29例、Ⅲ期57例;按内镜下肿瘤退缩情况分为瘢痕型27例、溃疡型16例、结节型20例、炎症水肿型23例。(2)影响直肠癌新辅助治疗达到near‑cCR行等待观察策略患者肿瘤复发的因素。多因素分析结果显示:年龄是直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者肿瘤复发的独立保护因素(优势比=0.88,95%可信区间为0.81~0.97,P<0.05);溃疡型肿瘤分型相对瘢痕型是其独立危险因素(优势比=4.22,95%可信区间为1.01~17.64,P<0.05)。(3)预后分析。136例达到near‑cCR患者随访时间为65(60~72)个月,86例行等待观察策略患者5年总生存率为84.9%,50例行腹腔镜直肠癌根治术患者5年总生存率为76.0%,两者生存情况比较,差异无统计学意义(χ²=1.94,P>0.05)。86例行等待观察策略患者中,瘢痕型、溃疡型、结节型、炎症水肿型患者5年总生存率分别为81.5%、75.0%、85.0%、95.7%;4者总生存率比较,差异无统计学意义(χ²=3.64,P>0.05)。

    结论 

    与行腹腔镜直肠癌根治术比较,直肠癌新辅助治疗后达到near‑cCR患者行等待观察策略安全、可行。年龄是直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者肿瘤复发的独立保护因素;与瘢痕型肿瘤分型比较,溃疡型是其独立危险因素。

    Abstract:
    Objective 

    To investigate the prognosis of rectal cancer patients with wait and see strategy after near clinical complete response(near-cCR) to neoadjuvant therapy and influencing factors for tumor recurrence.

    Methods 

    The retrospective cohort study was conducted. The clinico-pathological data of 463 patients with low advanced rectal cancer who underwent neoadjuvant therapy, including 89 cases in Shanxi Provincial People's Hospital and 374 cases in Shanxi Cancer Hospital, from January 2013 to December 2017 were collected. There were 258 males and 205 females, aged (62±7)years. Patients received efficacy evaluation at 6 weeks after neoadjuvant therapy, in which patients with near-cCR who adhered to wait and see strategy received 6 cycles of additional adjuvant chemotherapy after comprehensive reexaminations. Observation indicators: (1)situations of neoadjuvant therapy; (2) influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy; (3) prognostic analysis. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of count data between groups was conducted using the chi‑square test. Comparison of ordinal data was conducted using the nonparameter rank sum test. The Kaplan-Meier method was used to draw survival curve, and the log‑rank test was used for survival analysis. The binary logistic regression model was used for univariate and multivariate analyses.

    Results 

    (1)Situations of neoadjuvant therapy. There were 136 patients achieving near-cCR after neoadjuvant therapy, including 86 cases adhering to wait and see strategy and 50 cases undergoing laparoscopic radical resection of rectal cancer. Of 86 cases with wait and see strategy, 29 cases were in clinical stage Ⅱ and 57 cases were in stage Ⅲ. There were 27 cases of scar type, 16 cases of ulcer type, 20 cases of nodule type, 23 cases of inflammatory edema type based on endoscopic tumor regression. (2) Influencing factors for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Results of multivariate analysis showed that age was an indepen-dent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy (odds ratio=0.88, 95% confidence interval as 0.81-0.97, P<0.05). Compared with scar type, the ulcer type was an independent risk factor (odds ratio=4.22, 95% confidence interval as 1.01-17.64, P<0.05). (3) Prognostic analysis. All the 136 patients achieving near-cCR were followed up for 65(range, 60-72)months. The 5-year overall survival rate was 84.9% of 86 patients with wait and see strategy, versus 76.0% of 50 patients undergoing laparoscopic radical resection of rectal cancer, showing no significant difference between them (χ2=1.94, P>0.05). Of 86 patients with wait and see strategy, the 5-year overall survival rate was 81.5%, 75.0%, 85.0%, 95.7% for cases of scar type, ulcer type, nodule type, inflammatory edema type, showing no significant difference among them (χ2=3.64, P>0.05).

    Conclusions 

    Compared with laparoscopic radical resec-tion of rectal cancer, wait and see strategy is safe and feasible for rectal cancer patients after near-cCR to neoadjuvant therapy. Age is an independent protective factor for tumor recurrence of rectal cancer patients with wait and see strategy after near-cCR to neoadjuvant therapy. Compared with scar type, ulcer type is an independent risk factor.

  • 新辅助放化疗联合全直肠系膜切除术已成为进展期直肠癌降低复发率以及超低位Ⅱ期直肠癌提高保肛率的标准治疗方案[19]。新辅助治疗后50%~80%的直肠癌患者肿瘤降期,R0切除率可提高至70%,中低位直肠癌的保肛率为60%~80%,10%~30%的患者经治疗后肿瘤消失可达到临床完全缓解(clinical complete response,cCR)或病理学完全缓解(pathological complete response,pCR)[1021]。部分患者治疗后虽然无法达到严格的cCR标准,但手术切除后病理学复检已达pCR。该部分患者的后续治疗一直是该领域的焦点、难点问题[2224]。2015年研究者提出近临床完全缓解(near clinical complete response,near‑cCR)概念[21]。本研究回顾性分析2013年1月至2017年12月收治的463例(山西省人民医院89例、山西省肿瘤医院374例)低位进展期直肠癌行新辅助治疗患者的临床病理资料,探讨near‑cCR患者行等待观察策略的预后及肿瘤复发的影响因素。

    采用回顾性队列研究方法。收集463例低位进展期直肠癌行新辅助治疗患者的临床病理资料;男258例,女205例;年龄为(62±7)岁。本研究通过山西省肿瘤医院医学伦理委员会审批,批号为002 013jzcyj034。患者及其家属均签署知情同意书。

    纳入标准:(1)病理学检查确诊为直肠腺癌。(2)AJCC第7版肿瘤分期为Ⅱ~Ⅲ期。(3)肿瘤上极距肛缘距离≤7 cm。

    排除标准:(1)诊断直肠癌<5年,同时确诊其他恶性肿瘤。(2)未在研究者中心规律随访≥2年。(3)错配修复蛋白缺失或微卫星不稳定。(4)新辅助治疗后复查项目不全。(5)行经肛局部切除术。

    (1)放疗:采用调强放射治疗技术,肿瘤靶区放射剂量为50 Gy,2Gy/次,5次/周,治疗5周。(2)化疗:采用3周期新辅助化疗,化疗方案包括氟尿嘧啶或卡培他滨单药方案,或以氟尿嘧啶或卡培他滨为基础的联合化疗方案等。

    患者新辅助治疗后6周接受疗效评估。行等待观察策略的near‑cCR患者全面复查后追加辅助化疗6个疗程(化疗方案同新辅助化疗[1718])后等待观察直至进展,出现复发进展患者行腹腔镜直肠癌根治术。

    观察指标:(1)新辅助治疗情况。(2)影响直肠癌新辅助治疗达到near‑cCR行等待观察策略患者肿瘤复发的因素。(3)预后分析。

    评价标准:cCR评价方法和标准为新辅助治疗最后1次放疗后第6周,参照文献[8]的标准评估新辅助治疗后直肠癌病灶。(1)直肠指诊未触及结节或溃疡。(2)内镜检查结果示黏膜下白色瘢痕、新生毛细血管或正常肠壁,无溃疡或硬结,多点活组织病理学检查结果均为阴性。(3)MRI检查弥散加权成像或T2加权成像结果显示:原肿瘤部位表现为正常肠壁或显著纤维化。(4)CEA正常。(5)CT检查未见远处转移。

    near‑cCR标准:放化疗后经体格检查及辅助检查,发现肿瘤对放化疗有较好的反应,呈现瘢痕化为主的改变,但尚未达到cCR的诊断标准。内镜下可见表浅瘢痕、溃疡或结节但MRI、病理学检查结果均为阴性,其余参照cCR评价标准。

    采用门诊、电话、微信等方式进行随访。了解患者肿瘤复发和生存情况。随访时间截至2022年12月31日。

    应用SPSS 25.0统计软件进行分析。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。计数资料以绝对数表示,组间比较采用χ²检验。等级资料比较采用非参数秩和检验。采用Kaplan⁃Meier法绘制生存曲线,log‑rank检验进行生存分析。多因素分析采用二元logistic回归模型。P<0.05为差异有统计学意义。

    463例患者中,新辅助治疗后未达到near‑cCR患者327例,均行腹腔镜全直肠系膜直肠癌根治术。新辅助治疗后达到near‑cCR患者136例,其中86例行等待观察策略,50例行腹腔镜直肠癌根治术。86例行等待观察策略患者中,临床分期Ⅱ期29例、Ⅲ期57例;按内镜下肿瘤退缩情况分为瘢痕型27例、溃疡型16例、结节型20例、炎症水肿型23例。

    单因素分析结果显示:年龄、肿瘤体积、肿瘤分型均是影响直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者肿瘤复发的相关因素(P<0.05);齿状线上距离、肿瘤T分期、肿瘤N分期、组织学分级均不是影响直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者肿瘤复发的相关因素(P>0.05)。见表1。多因素分析结果显示:年龄是直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者肿瘤复发的独立保护因素(OR=0.88,95%CI为0.81~0.97,P=0.006);溃疡型肿瘤分型相对瘢痕型是其独立危险因素(OR=4.22,95%CI为1.01~17.64,P=0.049)。

    表1 影响86例低位进展期直肠癌新辅助治疗后

    达到近临床缓解行等待观察策略患者

    肿瘤复发的单因素分析

    Table 1 Univariate analysis of tumor recurrence

    in 86 locally advanced rectal cancer patients

    with wait and see strategy after near clinical

    complete response to neoadjuvant therapy

    临床病理因素赋值肿瘤复发统计量值P
    是(28例)否(58例)
    年龄(x±s,岁)-60±563±7t=2.140.036
    齿状线上距离(例)
    ≤3 cm11424Z=1.620.106
    >3 cm且<5 cm21421
    5~7 cm3013
    肿瘤体积(例)
    <1/2环周0728χ²=4.240.040
    1/2~3/4环周12130
    肿瘤T分期(例)
    T2期009χ²=3.340.068
    T3期12849
    肿瘤N分期(例)
    N+期12547χ²=0.440.510
    N0期0311
    组织学分级(例)
    低分化186χ²=3.360.067
    中分化02052
    肿瘤分型(例)
    瘢痕型1819χ²=8.690.034
    溃疡型297
    结节型3812
    炎症水肿型4320
    注:“-”为此项无
    下载: 导出CSV 
    | 显示表格

    136例达到near‑cCR患者随访时间为65(60~72)个月,86例行等待观察策略患者5年总生存率为84.9%,50例行腹腔镜直肠癌根治术患者5年总生存率为76.0%,两者生存情况比较,差异无统计学意义(χ²=1.94,P=0.164)。见图1

    图  1  136例低位进展期直肠癌新辅助治疗后达到近临床完全缓解患者行不同治疗方式的总生存曲线
    Figure  1.  Overall survival of 136 locally advanced rectal cancer patients with different treatments after near clinical complete response to neoadjuvant therapy

    86例行等待观察策略患者中,瘢痕型、溃疡型、结节型、炎症水肿型患者5年总生存率分别为81.5%、75.0%、85.0%、95.7%;4者总生存率比较,差异无统计学意义(χ²=3.64,P=0.303)。见图2

    图  2  86例低位进展期直肠癌新辅助治疗后达到近临床完全缓解行等待观察策略不同肿瘤分型患者的总生存曲线
    Figure  2.  Overall survival of different types of 86 locally advanced rectal cancer patients with wait and see strategy after near clinical complete response to neoadjuvant therapy

    2004年研究者提出直肠癌新辅助治疗后等待观察策略[17]。2018年发布的15个国家、47家医学中心1 009例新辅助治疗后行等待观察策略直肠癌患者的研究结果显示:880例达到cCR的患者中位随访时间为3.3年,2年内肿瘤局部复发的累积发生比例为25.2%,其中88%发生于2年内,97%发生于肠壁;肿瘤远处转移率为8%,患者5年总生存率和无病生存率分别为85%和94%[25]。该研究证实直肠癌行等待观察策略的安全性,也与现阶段结论相符[2630]。但目前临床实践中,研究者对pCR判断存在困惑,对治疗方案选择存在分歧。直肠癌新辅助治疗后的cCR概念和标准是研究的基础,可用于预测pCR[3133]。但目前临床医师评估cCR仍有不足[3436]

    本研究单因素分析结果显示:年龄、肿瘤体积、肿瘤分型是影响直肠癌新辅助治疗后达到near⁃cCR行等待观察策略患者肿瘤复发的相关因素。这与文献[22]相符。本研究多因素分析结果提示直肠癌新辅助治疗后达到near‑cCR行等待观察策略患者中,年轻的患者和肿瘤分型为溃疡型肿瘤需谨慎施行。已行等待观察策略患者需提高随访频率,如肿瘤复发需及时治疗。本研究预后分析结果显示:直肠癌新辅助治疗后达到near‑cCR患者行等待观察策略和行腹腔镜直肠癌根治术5年总生存率比较,差异无统计学意义;不同肿瘤分型行等待观察策略患者5年总生存率比较,差异也无统计学意义。这提示对于直肠癌新辅助治疗后达到near‑cCR患者行等待观察策略安全、可行。

    综上,与行腹腔镜直肠癌根治术比较,直肠癌新辅助治疗后达到near‑cCR患者行等待观察策略安全、可行。年龄是直肠癌新辅助治疗后达到near⁃cCR行等待观察策略患者肿瘤复发的独立保护因素;与瘢痕型肿瘤分型比较,溃疡型是其独立危险因素。

    任晓东、候生槐:查阅文献,收集数据,数据分析,起草文章;胡震、王若雅、李二峰:临床试验设计,数据分析;李耀平:研究设计与指导,论文审阅与修改,研究经费支持
    所有作者均声明不存在利益冲突
    任晓东, 胡震, 李耀平, 等. 直肠癌新辅助治疗后近临床完全缓解患者行等待观察策略的预后及肿瘤复发影响因素分析[J]. 中华消化外科杂志, 2024, 23(12): 1518-1523. DOI: 10.3760/cma.j.cn115610-20241124-00503.
    http://journal.yiigle.com/LinkIn.do?linkin_type=cma&DOI=10.3760/cma.j.cn115610-20241124-24503
  • 图  1   136例低位进展期直肠癌新辅助治疗后达到近临床完全缓解患者行不同治疗方式的总生存曲线

    Figure  1.   Overall survival of 136 locally advanced rectal cancer patients with different treatments after near clinical complete response to neoadjuvant therapy

    图  2   86例低位进展期直肠癌新辅助治疗后达到近临床完全缓解行等待观察策略不同肿瘤分型患者的总生存曲线

    Figure  2.   Overall survival of different types of 86 locally advanced rectal cancer patients with wait and see strategy after near clinical complete response to neoadjuvant therapy

    临床病理因素赋值肿瘤复发统计量值P
    是(28例)否(58例)
    年龄(x±s,岁)-60±563±7t=2.140.036
    齿状线上距离(例)
    ≤3 cm11424Z=1.620.106
    >3 cm且<5 cm21421
    5~7 cm3013
    肿瘤体积(例)
    <1/2环周0728χ²=4.240.040
    1/2~3/4环周12130
    肿瘤T分期(例)
    T2期009χ²=3.340.068
    T3期12849
    肿瘤N分期(例)
    N+期12547χ²=0.440.510
    N0期0311
    组织学分级(例)
    低分化186χ²=3.360.067
    中分化02052
    肿瘤分型(例)
    瘢痕型1819χ²=8.690.034
    溃疡型297
    结节型3812
    炎症水肿型4320
    注:“-”为此项无
    下载: 导出CSV
  • [1]

    NiuS, ChenY, PengF, et al. The role of MRI after neoche-moradiotherapy in predicting pathological tumor regre-ssion grade and clinical outcome in patients with locally advanced rectal adenocarcinoma[J]. Front Oncol,2023,13:1118518. DOI: 10.3389/fonc.2023.1118518.

    [2]

    KasiA, AbbasiS, HandaS, et al. Total neoadjuvant therapy vs standard therapy in locally advanced rectal cancer: a systematic review and meta‑analysis[J]. JAMA Netw Open,2020,3(12):e2030097. DOI:10.1001/jamanetworkopen. 2020.30097.

    [3]

    FernandesMC, GollubMJ, BrownG. The importance of MRI for rectal cancer evaluation[J]. Surg Oncol,2022,43:101739. DOI: 10.1016/j.suronc.2022.101739.

    [4]

    GoodmanKA. Total neoadjuvant therapy for rectal cancer[J]. Cancer Radiother,2018,22(5):459‑465. DOI: 10.1016/j.canrad.2018.01.004.

    [5]

    RubioGA, HurstRD, UmanskiyK, et al. Neoadjuvant therapy for cT2N0M0 rectal cancer?[J]. J Gastrointest Surg,2022,26(2):479‑482. DOI: 10.1007/s11605-021-05125-8.

    [6]

    BodyA, PrenenH, LamM, et al. Neoadjuvant therapy for locally advanced rectal cancer: recent advances and ongo-ing challenges[J]. Clin Colorectal Cancer,2021,20(1):29-41. DOI: 10.1016/j.clcc.2020.12.005.

    [7]

    El HomsiM, BerczA, ChahwanS, et al. Watch & wait‑post neoadjuvant imaging for rectal cancer[J]. Clin Imaging,2024,110:110166. DOI: 10.1016/j.clinimag.2024.110166.

    [8]

    JohnsonD, LiL, LeeKC, et al. Total neoadjuvant therapy for high risk rectal cancer in Western and Asian popula-tions‑current evidence and clinical applications[J]. Clin Colorectal Cancer,2022,21(1):45‑54. DOI:10.1016/j.clcc. 2021.12.004.

    [9] 顾磊,徐庆.直肠癌经肛全直肠系膜切除术的现状与思考[J].肿瘤,2023,43(5):382-388. DOI:10.3781/j.issn.1000-7431. 2023.2303-0094.
    [10] 杨盈,孟文建,王自强.结直肠癌的综合治疗[J].中华消化外科杂志,2022,21(6):753-765. DOI: 10.3760/cma.j.cn115610-20220505-00251.
    [11] 中华人民共和国国家卫生健康委员会.中国结直肠癌诊疗规范(2023版)[J].中华消化外科杂志,2023,22(6):667-698. DOI: 10.3760/cma.j.cn115610-20230526-00236.
    [12] 张建锋,于滨,张振亚,等.中低位直肠癌新辅助治疗后全系膜切除术的难点与对策[J].中华消化外科杂志,2023,22(6):724-728. DOI: 10.3760/cma.j.cn115610-20230425-00185.
    [13] 楼征,张卫.超低位直肠癌的保肛手术及综合治疗[J].中华消化外科杂志,2023,22(6):714-718. DOI: 10.3760/cma.j.cn115610-20230415-00169.
    [14] 魏鹏宇,任明扬,张宏宇,等.中国taTME病例登记协作研究数据库中直肠癌手术标本质量分析:一项全国性登记研究[J].中华消化外科杂志,2023,22(6):736-741. DOI: 10.3760/cma.j.cn115610-20230519-00221.
    [15]

    Quezada‑DiazFF, SmithJJ. Neoadjuvant therapy for rectal cancer[J]. Surg Oncol Clin N Am,2022,31(2):279‑291. DOI: 10.1016/j.soc.2021.11.008.

    [16]

    CianciR, CristelG, AgostiniA, et al. MRI for rectal cancer primary staging and restaging after neoadjuvant chemo-radiation therapy: how to do it during daily clinical prac-tice[J]. Eur J Radiol,2020,131:109238. DOI:10.1016/j.ejrad. 2020.109238.

    [17]

    SauerR, BeckerH, HohenbergerW, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J]. N Engl J Med,2004,351(17):1731‑1740. DOI:10.1056/NEJ Moa040694.

    [18]

    SchlechterBL. Management of rectal cancer[J]. Hematol Oncol Clin North Am,2022,36(3):521‑537. DOI: 10.1016/j.hoc.2022.03.002.

    [19]

    GérardJP, ConroyT, BonnetainF, et al. Preoperative radio-therapy with or without concurrent fluorouracil and leu-covorin in T3‑4 rectal cancers: results of FFCD 9203[J]. J Clin Oncol,2006,24(28):4620‑4625. DOI:10.1200/JCO.2006. 06.7629.

    [20]

    GollinsS, Sebag‑MontefioreD. Neoadjuvant treatment stra-tegies for locally advanced rectal cancer[J]. Clin Oncol (R Coll Radiol),2016,28(2):146‑151. DOI:10.1016/j.clon.2015. 11.003.

    [21]

    VailatiBB, São JuliãoGP, Habr‑GamaA, et al. Nonoperative management of rectal cancer: the watch and wait strategy[J]. Surg Oncol Clin N Am,2022,31(2):171‑182. DOI:10.10 16/j.soc.2021.11.003.

    [22]

    NakagawaWT,RossiBM,de O FerreiraF,et al.Chemoradia-tion instead of surgery to treatmid and low rectal tumors: is it safe?[J]. Ann Surg Oncol,2002,9(6):568-573.

    [23] 张惠茅,高嘉怡.基于医学影像的人工智能技术在结直肠癌中的研究现状及展望[J].兰州大学学报:医学版,2022,48(8):1-4. DOI: 10.13885/j.issn.1000-2812.2022.08.001.
    [24]

    Glynne‑JonesR, Glynne‑JonesS. The concept and use of the neoadjuvant rectal score as a composite endpoint in rectal cancer[J]. Lancet Oncol,2021,22(7):e314‑e326. DOI: 10.1016/S1470-2045(21)00053-X.

    [25]

    van der ValkM, HillingDE, BastiaannetE, et al. Long‑term outcomes of clinical complete responders after neoadju-vant treatment for rectal cancer in the International Watch & Wait Database (IWWD): an international multicentre registry study[J]. Lancet,2018,391(10139):2537‑2545. DOI: 10.1016/S0140-6736(18)31078-X.

    [26]

    JayaprakasamVS, AlvarezJ, OmerDM, et al. Watch-and-wait approach to rectal cancer: the role of imaging[J]. Radiology,2023,307(1):e221529. DOI: 10.1148/radiol.221529.

    [27]

    VailatiBB, São JuliãoGP, Habr‑GamaA, et al. Nonoperative management of rectal cancer: the watch and wait strategy[J]. Surg Oncol Clin N Am,2022,31(2):171‑182. DOI:10.10 16/j.soc.2021.11.003.

    [28]

    DossaF, ChesneyTR, AcunaSA, et al. A watch‑and‑wait approach for locally advanced rectal cancer after a clinical complete response following neoadjuvant chemoradiation: a systematic review and meta‑analysis[J]. Lancet Gastroenterol Hepatol,2017,2(7):501‑513. DOI: 10.1016/S2468-1253(17)30074-2.

    [29]

    López‑CamposF, Martín‑MartínM, Fornell‑PérezR, et al. Watch and wait approach in rectal cancer: current contro-versies and future directions[J]. World J Gastroenterol,2020,26(29):4218‑4239. DOI: 10.3748/wjg.v26.i29.4218.

    [30]

    YuvalJB, Garcia‑AguilarJ. Watch‑and‑wait management for rectal cancer after clinical complete response to neo-adjuvant therapy[J]. Adv Surg,2021,55:89‑107. DOI:10.10 16/j.yasu.2021.05.007.

    [31] 刘英强,陈淅涓,韩广森,等.中低位局部进展期直肠癌新辅助同步放化疗敏感性与环氧化酶‑2表达的关系[J].中华实验外科杂志,2018,35(8):1548‑1550. DOI: 10.3760/cma.j.issn.1001-9030.2018.08.049.
    [32] 张潇,高加勒,杨正阳,等.磁共振成像检查预测局部进展期直肠癌免疫联合新辅助治疗后病理学完全缓解的临床价值[J].中华消化外科杂志,2022,21(11):1467‑1474. DOI:10. 3760/cma.j.cn115610-20220831-00484.
    [33]

    SarafA, RobertsHJ, WoJY, et al. Optimal neoadjuvant stra-tegies for locally advanced rectal cancer by risk assess-ment and tumor location[J]. J Natl Compr Canc Netw,2022,20(10):1177‑1184. DOI: 10.6004/jnccn.2022.7061.

    [34]

    VerrijssenAS, GuillemJ, PerezR, et al. Microscopic intra-mural extension of rectal cancer after neoadjuvant chemora-diation: a meta‑analysis based on individual patient data[J]. Radiother Oncol,2020,144:37‑45. DOI:10.1016/j.rado nc.2019.10.003.

    [35]

    KaliszKR, EnzerraMD, PaspulatiRM. MRI evaluation of the response of rectal cancer to neoadjuvant chemoradia-tion therapy[J]. Radiographics,2019,39(2):538‑556. DOI: 10.1148/rg.2019180075.

    [36]

    Cerdán‑SantacruzC, VailatiBB, São JuliãoGP, et al. Watch and wait: why, to whom and how[J]. Surg Oncol,2022,43:101774. DOI: 10.1016/j.suronc.2022.101774.

图(3)  /  表(1)
计量
  • 文章访问数:  3
  • HTML全文浏览量:  0
  • PDF下载量:  5
  • 被引次数: 0
出版历程
  • 收稿日期:  2024-11-23
  • 刊出日期:  2024-12-19

目录

/

返回文章
返回