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Lancet Gastroen Hepatol:观察等待疗法可否有效治疗直肠癌?

2017-05-05 tianxuexin MedSci原创

对于新辅助化放疗后临床完全缓解的患者实施watch-and-wait方法可以避免常规手术增加直肠癌病情加重的风险。但是,这种方法的安全性还不清楚。基于此,该研究评估了watch-and-wait方法治疗直肠癌的有效性和可靠性。

对于新辅助化放疗后临床完全缓解的患者实施观察等待疗法watch-and-wait)可以避免常规手术增加直肠癌病情加重的风险。但是,这种方法的安全性还不清楚。基于此,该研究评估了观察等待疗法治疗直肠癌的有效性和可靠性。

该研究系统地搜索MEDLINE,Embase和the grey文献(截至2016年6月28日)研究直肠癌患者经过新辅助化放疗产生临床反应后,在观察等待疗法治疗下的反应。该研究调查了在实施观察等待疗法后的肿瘤2年本地再生长的比例。通过研究比较实施观察等待疗法的患者、检测到临床完全反应后进行根治性手术的患者和表现直肠癌病理完全反应的患者的后期状况,评估了相关的非再生长复发,癌症特异性死亡率,无病生存率和总体生存率。

该项目建立了23项实验,共有867例平均随访12-68个月的患者。汇总的2年本地再生长为15.7%(95%CI 11·8-20·1); 其中95.4%(95%CI 89·6-99·3)的再生长患者进行了抢救治疗。临床完全缓解后观察等待疗法治疗患者与初次发病患者切除病理完全缓解后体征无显着差异(风险比[RR] 1·46,95%CI 0· 70-3.05)、癌症特异性死亡率(RR 0·87,95%CI 0·38-1·99)。组间总生存率差异无统计学意义(风险比[HR] 0·73,95%CI0·35-1·51),手术组无病生存率较好(HR0.47,95 %CI 0·28-0·78)。研究人员发现,在watch-and-wait治疗的患者与接受手术治疗的临床完全缓解患者中各研究项目均无明显差异:非再生复发(RR 0。58,95%CI 0·18-1·90),癌症 - 特异性死亡率(RR 0·58,95%CI 0·06-5·84),无病生存率(HR0.56,95%CI0·20-1·60)或总生存期(HR 3·91 ,95%CI 0·57-26·72)。

该研究得出结论,大多数通过观察等待疗法治疗的患者无需再进行根治性手术,而那些肿瘤再生长的患者几乎都接受了救助治疗。虽然我们发现在观察等待疗法与手术治疗的患者中,非再生长性癌症复发或总体生存率没有显着差异,但统计案例过少,因此需要更多的前瞻性研究来确认观察等待疗法的长期安全性。

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    2018-03-22 许安
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    2018-03-16 howi
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    2017-05-07 gwc384
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