中低位直肠癌新辅助放化疗后病理完全缓解预测因素分析

目的 探讨预测中低位直肠癌新辅助放化疗后病理完全缓解（pCR）的临床因素。方法 回顾性分析2013年1月至2016年10月中山大学附属第六医院收治的行新辅助放化疗联合全直肠系膜切除手术治疗的185例进展期中低位直肠癌病人的临床病理资料，包括年龄、治疗前癌胚抗原（CEA）、病理类型及分期、新辅助化疗方案、放疗结束至手术间隔时间等。根据肿瘤治疗反应分为pCR组（49例）和non-pCR组（136例），计算pCR率并分析其影响因素。结果 术后49例（26.5%）病人达到pCR，103例病人病理学疗效分级为0或1，总降期率为55.8%。单因素分析显示，肿瘤T分期（P=0.004）和N分期（P=0.032）、治疗前CEA水平（P=0.039）、化疗方案（P=0.003）与pCR相关；多因素分析显示，T2分期和化疗方案中含有奥沙利铂是pCR的独立影响因素。结论 T2分期和以氟尿嘧啶为基础同时联合奥沙利铂的化疗方案是影响中低位直肠癌新辅助放化疗pCR的独立预测因素。     

直肠癌新辅助放化疗后病理完全缓解预测因素分析

目的探讨影响直肠癌新辅助放化疗后病理完全缓解的相关预测因素。方法回顾性分析2007年1月至2013年5月间福建医科大学附属协和医院结直肠外科同一组医师收治的163例直肠癌新辅助放化疗及手术的临床资料。采用单因素分析及Logistic多因素分析法研究病理完全缓解（pCR）的相关预测因素。结果全组患者新辅助放化疗后有29例（17.8％,29／163）达pCR。单因素分析结果显示,肿瘤占据肠腔环周比例小于或等于1／2周（P=0．018）、病理类型为非黏液腺癌（P=0．036）、分化程度为高分化或中分化（P=0．021）及放化疗前CEA小于或等于2．5μg／L（P=-0．007）与直肠癌新辅助放化疗后高pCR率有关。多因素回归分析结果显示,肿瘤占据肠腔环周比例小于或等于1／2周（OR=2．901,P=0．020）和放化疗前CEA小于或等于2．5μg／L（OR=2．775,P-0．022）是影响直肠癌新辅助放化疗后pCR的独立因素。结论肿瘤占据肠腔环周比例和放化疗前CEA检测水平有助于预测直肠癌新辅助放化疗后的pCR率。     

直肠癌新辅助放化疗临床完全缓解后处理的争议与共识

直肠癌的治疗目标包括病人的长期生存和功能的保留。直肠癌新辅助治疗后约有20%的病人达到病理完全缓解（pCR）,如何利用现有检测手段甄选出真正pCR病人,使临床完全缓解（cCR）与pCR获得最大程度的符合度,提高保肛率或非手术治疗率,最终减少根治性手术创伤和功能损害,是目前研究的焦点。同时,cCR病人后续处理策略的选择,如‌“等待-观察”,还是局部切除或根治性手术,目前尚缺少循证医学证据支持,亦是目前争议热点。直肠癌新辅助放化疗后cCR后处理应遵循目标导向、分层治疗和全程管理原则。建议在拥有丰富直肠癌综合治疗经验的多学科诊疗团队的临床中心开展,严格筛选病例,综合考虑病人的治疗意愿、基线分期、病灶特征选择治疗策略。同时,不断完善cCR 的评估标准和随访策略,及时补救根治性手术,才能保证肿瘤学安全性和良好的功能和预后。     

直肠癌新辅助化疗病理完全缓解1例并文献复习

【摘要】〓目的〓探讨进展期结直肠癌新辅助化疗的临床疗效。方法〓报道中山大学孙逸仙纪念医院胃肠外科收治的1例接受新辅助化疗的进展期直肠癌患者的诊疗经过,并复习相关文献。 结果〓经过3疗程的新辅助化疗,患者术后病理结果提示完全病理缓解(pCR)。结论〓新辅助化疗对进展期结直肠癌患者是有效的,适合在进展期结直肠癌患者术前应用。     

直肠癌新辅助放化疗完全缓解后的处理策略

新辅助放化疗（neoadjuvant chemoradiation therapy,NeoCRT）已经成为局部进展期直肠癌（T3、T4、TxN1-2）规范治疗手段之一.直肠癌新辅助放化疗获得降期反应的比例约为60%,其中临床完全缓解（clinical complete remission,cCR）患者的比例在10%～50%[1].随着放化疗技术的发展,可以预期,直肠癌新辅助放化疗完全缓解率还会呈现不断提高的趋势.如何合理治疗获得cCR的患者,已经成为治疗直肠癌亟待解决的一个课题.     

低位局部进展期直肠癌新辅助放化疗后完全缓解的后续手术治疗效果

目的 探讨低位局部进展期直肠癌新辅助放化疗后完全缓解病例的进一步治疗方案及效果。方法 回顾性分析江苏省中医院肿瘤外科2008年1月至2010年5月期间行新辅助放化疗后初步判断达到病理完全缓解（pCR）的14例低位局部进展期直肠癌患者的临床资料。结果 14例患者中接受手术者10例,术后真正达到pCR者5例;术后2例复发或转移,其中死亡1例,1例带瘤生存,余8例患者均无瘤生存。未行手术的4例患者中,有3例复发或转移,其中2例死亡,1例带瘤生存;余1例无瘤生存。 4例未行手术病例中CEA水平正常者（＜5 μg/L）2例（1例复发或转移）,CEA升高的2例均发生转移;10例手术病例中CEA水平正常者6例（均无瘤生存,4例真正达到pCR）,升高者4例（1例真正达到pCR,2例复发或转移）。结论 接受新辅助放化疗后初步判断达到pCR的病例,尤其是CEA值高于正常者,应接受规范的全直肠系膜切除（TME）手术以达到根治的目的。     

直肠癌新辅助治疗后临床完全缓解处理策略的争议与困惑

自新辅助化疗概念被提出以来,直肠癌新辅助治疗经过了新辅助化疗、新辅助放疗、新辅助放化疗的研究历程,并证明新辅助放化疗治疗模式与其他治疗方案相比能够使进展期直肠癌获得最大的术前疗效,肿瘤直径较治疗前平均缩小53.1%,获得降期的反应比例可达68%,提高保肛率38%,90%以上患者可获R0切除,与手术后辅助治疗相比降低了5年局部复发率（8.1%比16.5%,P〈0.05）。更重要的是,部分患者获得了临床完全缓解（clinical complete response,c CR）,综合资料显示,获得cCR的病例经手术后病理验证只有10%～30%能够达到病理完全缓解（pathological complete response,pCR）。因此,在病理未明确之前对cCR患者如何处理是目前困扰广大学者的一个主要难题,也是直肠癌新辅助治疗中争议最大的部分。     

系统性炎症指标与局部晚期乳腺癌新辅助化疗后病理完全缓解的关系

目的 探讨系统性炎症指标对局部晚期乳腺癌经新辅助化疗（neoadjuvant chemotherapy,NACT后实现病理完全缓解（pathological complete response,pCR）的影响及其预测价值。方法 回顾性分析2019年2月至2022年2月期间于西南医科大学附属医院乳腺外科接受NACT后并根治性手术切除的女性局部晚期乳腺癌患者（简称“患者”）的临床病理资料。采用多因素logistic回归分析影响NACT后实现pCR的影响因素并建立pCR预测模型,采用受试者操作特征曲线及其曲线下面积评估pCR预测模型的效能。结果 共纳入98例患者,其中有29例患者NACT后获得了pCR,pCR率为29.6%。多因素二元logistic回归分析结果发现,处于未绝经状态、雌激素受体阴性、采用化学药物治疗（简称“化疗”）+靶向治疗方案和系统性免疫炎症指数<532.70（最佳临界值）的患者NACT后更容易获得pCR(P<0.05),据此构建的预测模型为：logit(P)=0.697–2.974×绝经状态–1.932×雌激素受体状态+3.277×化疗方案–2.652×系统性...     

直肠癌术前新辅助放化疗的相关问题

近年研究结果显示,借助术前新辅助放化疗提高局部进展期中低位直肠癌的局部控制率和保肛率,是直肠癌辅助治疗的新趋势。术前新辅助放疗或放化疗对直肠癌的局部治疗效果要优于单纯手术或手术后的放化疗。随着多中心大样本研究的长期随访结果报道的发表,新辅助治疗的疗效进一步得到了认可,逐渐成为直肠癌综合治疗的标准方案。其优点有：（1）放疗使癌细胞退变、凋亡,     

预测食管癌新辅助放化疗后病理完全缓解的临床指标

本研究旨在确定新辅助放化疗后预测食管癌患者病理完全缓解（pCR）的临床指标。共计322例接受新辅助放化疗的食管癌患者入组。所有患者均在治疗前后行PET．CT检查及内镜活检。其中70例（21．7％）获得pCR,     

Surgery may not benefit patients with locally advanced rectal cancer who achieved clinical complete response following neoadjuvant chemoradiotherapy

PurposeWe compared the long-term outcome of the watch and wait (WW) strategy and surgery in patients with locally advanced rectal cancer.Patients and methodsThis prospective cohort study included 84 patients who achieved clinical complete response (cCR) after neoadjuvant chemoradiotherapy (NCRT). They were divided into the WW group (n = 58) and surgery group (SG, n = 26). Patients in the SG underwent total mesorectal excision. The study site was the Peking University Cancer Hospital.ResultsEighty-four patients were included (58 and 26 in the WW group and SG, respectively). A total of 76·9% of the patients in the SG achieved pathological complete response (pCR) and 23·1% of the patients had a residual tumor. The total recurrence and metastasis rate was 15·4% (4/26) in the SG and 18·9% (11/58) in the WW group. There was no significant difference in the recurrence and metastasis rate between the two groups. In the WW group, 9 cases developed tumor regrowth during follow-up and underwent salvage surgery. The overall survival rate of the WW group (96·6% vs 92·3%) was not significantly different from that of the SG (P > 0·05). The WW patients also retained their anal sphincter function and avoided surgery-related complications.ConclusionThe WW strategy is a feasible treatment option in patients with cCR after NCRT. Surgery may not bring benefits to these cCR patients.     

Accuracy of high-resolution rectal magnetic resonance imaging re-staging with histopathology in locally advanced rectal cancer after neoadjuvant chemoradiotherapy

Background/objectiveRe-staging of locally advanced rectal cancer (LARC) following neoadjuvant chemoradiotherapy (NCRT) is a crucial step in surgical decision-making. Currently, MRI is the imaging of choice for evaluation of LARCs, however, the diagnostic accuracy of this modality is inconsistent. In this study, we evaluated the diagnostic accuracy of MRI in LARC and analyzed the factors that influenced the accuracy.MethodsThe records of 133 patients diagnosed with LARC who were operated on during 2011–2018 were retrospectively reviewed. All patients received NCRT followed by re-staging based on high-resolution rectal MRI. The MRI results were analyzed for their yT and yN accuracy and anal sphincter involvement and compared with the related histopathological studies after definitive surgery.ResultsRe-staging MRIs gave overall accuracy in both the yT stage and yN evaluation of 85% (K 0.45 and 0.21, respectively). The MRI tended to overstaging for tumor invasion and understaging for lymph node involvement (sign test p-values = 0.017 and 0.022, respectively.) The highest accuracy of the yT stage was yT4b (93%, K 0.71). The study found that larger tumors (>3 cm) were associated with significantly higher accuracy in the yT readings while lack of lymphovascular invasion was associated with higher accuracy in the yN readings. The negative predictive value for anal sphincter involvement was 100%.ConclusionMRI has limited accuracy in post-NCRT re-staging in LARC, tending to give overstaged yT readings and understaged yN readings. An MRI exclusion of sphincteric involvement is highly reliable.     

新辅助放化疗联合全直肠系膜切除术治疗局部进展期直肠癌的疗效及安全性分析

目的 分析新辅助放化疗联合全直肠系膜切除术治疗局部进展期直肠癌的疗效及安全性。方法 回顾性分析广西医科大学第四附属医院2017年6月至2020年6月收治并行全直肠系膜切除术的局部进展期直肠癌患者的临床资料,共100例,按是否行新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)分为nCRT组(50例)和非n CRT组(50例)。比较两组患者治疗后的临床指标、术后并发症及对比新辅助放化疗前后肿瘤TNM分期。结果 新辅助放化疗后肿瘤分期明显下降。nCRT组患者新辅助放化疗后的术中出血量、保护性造口率高于非nCRT组,手术时间、术后住院时间长于非nCRT组,淋巴结清扫数及保肛率低于非nCRT组,差异均有显著性(P<0.05)。nCRT组和非nCRT组治疗后总体并发症发生率比较,差异无显著性(P> 0.05)。结论新辅助放化疗联合全直肠系膜切除术治疗虽然增加直肠癌患者的保护性造口率、延长手术时间、增加手术出血,但可明显降低肿瘤分期。     

新辅助治疗局部进展期低位直肠癌老年病人的疗效评估

目的:探讨新辅助治疗对低位局部进展期(T3或T4)直肠癌老年病人(65岁以上)的疗效,并探讨其安全性。方法:分析2001年6月至2008年4月共105例的老年低位局部进展期直肠癌病人(距肛≤6cm)的临床资料。全部病例均先予以放疗(40～46)Gy/(20～23)次,每周5次,每次2Gy,休息2d,共4～5周。放疗结束休息6周后进行手术。在放疗同时进行化疗,口服卡培他滨1250mg/(m2·d),分2次口服,直至手术。手术按直肠全系膜切除(total mesorectal excision,TME)原则进行。结果:全部病人均完成了预定的新辅助治疗,其中67例出现副反应(其中有1例于放疗结束后的休息期间出现脑血管意外,经内科继续治疗3个月后再行手术切除)。8例(7.6%)病人经复查肿瘤完全消失,故未行手术,予随访观察。97例(92.4%)按TME原则行直肠癌根治术。手术标本显示:肿瘤已完全消失者12例(故加上未行手术的8例,经放、化疗肿瘤已完全消失者共20例);降期者59例(56%)。95例病人保肛手术,保肛率达90.5%。在行保肛手术病人中,发生吻合口漏5例(4.8%)。本研究的105例病人全部获得随访,随访期12～92个月,中位期为53个月。在随访期中,发现肺转移5例(4.8%)、肝转移3例(2.9%)、局部复发4例(3.8%),总复发率达11.43%;死亡12例,其中5例死于非肿瘤相关疾病。结论:新辅助放化疗在治疗过程中,降期作用明显、复发率低、耐受性好,是目前低位局部进展期直肠癌老年病人安全、合适的治疗方案。     

Accuracy of pathologic examination in detection of complete response after chemoradiation for esophageal cancer

BACKGROUND: Although a substantial proportion of patients undergoing neoadjuvant chemoradiation for invasive esophageal cancer develop a pathologic complete response (pCR), these patients nonetheless have a poor 5-year survival rate. We hypothesized that routine pathologic examination fails to identify some residual cancer. METHODS: Patients undergoing esophagectomy for cancer at 2 tertiary care centers were identified. Archived tumor blocks were retrieved for patients with pCR, sectioned at 50-mum intervals and reexamined for residual cancer. RESULTS: Seventy patients underwent neoadjuvant chemoradiation. Tumor blocks were available for 23 of 26 complete responders. A total of 159 blocks were reexamined. One patient was found to have a possible focus of residual invasive adenocarcinoma versus high-grade dysplasia. The remaining 22 patients had no residual disease. CONCLUSIONS: A more aggressive examination protocol for postchemoradiation esophagectomy specimens may not result in significant upstaging. Inadequate pathologic examination is likely not a major factor in the suboptimal survival in patients with pCR.     

Retrospective research of neoadjuvant therapy on tumor-downstaging,post-operative complications,and prognosis in locally advanced rectal cancer

BACKGROUNDNeoadjuvant therapy (NAT) is becoming increasingly important in locally advanced rectal cancer. Hence, such research has become a problem.AIMTo evaluate the downstaging effect of NAT, its impact on postoperative complications and its prognosis with different medical regimens.METHODSSeventy-seven cases from Shanghai Ruijin Hospital affiliated with Shanghai Jiaotong University School of Medicine were retrospectively collected and divided into the neoadjuvant radiochemotherapy (NRCT) group and the neoadjuvant chemotherapy (NCT) group. The differences between the two groups in tumor regression, postoperative complications, rectal function, disease-free survival, and overall survival were compared using the χ² test and Kaplan-Meier analysis.RESULTSBaseline data showed no statistical differences between the two groups, whereas the NRCT group had a higher rate of T4 (30/55 vs 5/22, P < 0.05) than the NCT groups. Twelve cases were evaluated as complete responders, and 15 cases were evaluated as tumor regression grade 0. Except for the reduction rate of T stage (NRCT 37/55 vs NCT 9/22, P < 0.05), there was no difference in effectiveness between the two groups. Preoperative radiation was not a risk factor for poor reaction or anastomotic leakage. No significant difference in postoperative complications and disease-free survival between the two groups was observed, although the NRCT group might have better long-term overall survival.CONCLUSIONNAT can cause tumor downstaging preoperatively or even complete remission of the primary tumor. Radiochemotherapy could lead to better T downstaging and promising overall survival without more complications.     

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目的 评价盆腔脏器联合切除术（PE）对局部进展期直肠癌的疗效。方法 对12年中79例局部进展期直肠癌PE术后结果进行回顾性总结。结果 全盆腔脏器切除术（TPE）46例，其中保肛TPE5例，TPE联合骶骨切除1例，TPE联合半骨盆切除1例，后盆腔脏器切除术（PPE）33例。根治性切除65例（82．8％），合并症发生率48．6％，手术死亡2例（2．5％），根治术后再复发36例（58．1％），术后1、3、5年生存率75．8％、39．3％、35．8％。根治性切除与大体根治切除术后3年、5年生存率分别为44．2％、40．8％与11．1％、0。结论 PE是目前治疗局部进展期直肠癌有效的方法，积极的根治性切除病灶，可以有效提高其治愈率，改善生活质量。