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JAMA SURGERY:局部晚期直肠癌患者未完成新辅助放疗与生存的关系

2017-07-09 MedSci MedSci原创

结直肠癌患者未完成化疗对患者生存具有不利影响。但是未完成新辅助放疗的影响尚不清楚。JAMA SURGERY近期发表了一篇文章,研究不完整的放疗是否与患者不良预后有关。

结直肠癌患者未完成化疗对患者生存具有不利影响。但是未完成新辅助放疗的影响尚不清楚。JAMA SURGERY近期发表了一篇文章,研究不完整的放疗是否与患者不良预后有关。

作者共收集了2006年-2012年接受新辅助放化疗后接受手术切除的Ⅱ-Ⅲ期直肠癌患者17600例。使用多因素分析比较术前接受完整剂量(45.0-50.4Gy)与不完整剂量(<45.0Gy)患者的切缘阳性,永久结肠造口率,30天再入院,90天死亡,以及总生存情况。在纳入的17600例患者中,10862例为男性,平均年龄59岁。其中874例患者接受不完整剂量的新辅助放疗。接受不完整剂量的患者接受的平均放疗剂量为34.2Gy。女性以及不是在进行手术的同一家医院接受放疗是放疗剂量不完整的独立预测因素。个人保险水平是完成放疗的预测因素。经过5年的随访,接受完整放疗的患者总生存情况更好(73.2% vs 63.0%)。调整了人口学、临床及肿瘤特征后,接受完整放疗的患者与未接受完整放疗的患者相比切缘阳性,永久结肠造口率,30天再入院率,90天死亡率相似。但是,接受完整的放疗剂量患者长期死亡率风险显着下降。

文章最后认为,接受目标放疗剂量45.0-50.4Gy与局部晚期直肠癌患者生存获益有关。综合考虑肿瘤患者各方面信息有助于患者接受完整的新辅助治疗。

原始出处:
Kyle Freischlag,Zhifei Sun,et al.Association Between Incomplete Neoadjuvant Radiotherapy and Survival for Patients With Locally Advanced Rectal Cancer.JAMA SURGERY.June 2017 doi:10.1001/jamasurg.2017.0010

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    2018-03-03 chg121
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time=2017-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220758, encodeId=60a5220e589c, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Jul 10 16:48:18 CST 2017, time=2017-07-10, status=1, ipAttribution=)]
    2017-07-11 chg122
  8. 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time=2017-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220758, encodeId=60a5220e589c, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Jul 10 16:48:18 CST 2017, time=2017-07-10, status=1, ipAttribution=)]
    2017-07-11 xuyu
  9. 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time=2017-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220758, encodeId=60a5220e589c, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Jul 10 16:48:18 CST 2017, time=2017-07-10, status=1, ipAttribution=)]
    2017-07-10 虈亣靌

    讲解的非常好,值得学习

    0

  10. 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time=2017-07-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=220758, encodeId=60a5220e589c, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=89, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=550d2008262, createdName=luominglian113, createdTime=Mon Jul 10 16:48:18 CST 2017, time=2017-07-10, status=1, ipAttribution=)]
    2017-07-10 luominglian113

    学习了,谢谢分享

    0

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本研究旨在于比较早期肠内营养与早期肠外营养对直肠重大手术后的直接疗效和血浆氨基酸浓度的影响。之前的研究曾经显示,血浆谷氨酰胺浓度降低预示ICU患者预后较差。

Ann Surg:开放式手术与腹腔镜手术治疗晚期低位直肠癌,哪个更好?

目前,直肠癌的腹腔镜手术在全世界范围内得到广泛的应用,并且已经报道了几项随机对照试验。然而,与开放手术相比,腹腔镜手术的有用性尚未充分评估、证明,特别是对于低位直肠区域。近期,一项发表在杂志Ann Surg上的研究旨在探讨腹腔镜原发性肿瘤切除术与局部晚期低位直肠癌开放手术相比较,其安全性与有效性如何。研究者们收集并分析了临床Ⅱ〜Ⅲ期的腹膜反射以下低位直肠癌患者的资料。这些患者均在2010年至201

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