2016-06-08 佚名 医脉通
2016年6月3-7日，一年一度的美国临床肿瘤学会（American Society of Clinical Oncology，ASCO）年会在芝加哥举办。6月5日上午的消化系统（结直肠）肿瘤口头报告专场上，一项摘要号为3507的CREST试验（英国结直肠内镜下支架置入术试验），是一项在梗阻性结直肠癌中将支架置入术作为手术桥梁的随机III期研究，整理如下：在有可能治愈的梗阻性左半结直肠癌患者中
来自39个中心的246例患者在2009年到2014年之间被随机分组，98%的患者遵从分配的治疗。92%接受以治愈为目的的治疗。30天术后死亡率（5.3% vs 4.4%）和住院时间长度[15.5天（IQR 10-26）vs 16天（10-27）]在支架置入组和手术组是相似的。支架置入术在82%的患者中实现梗阻缓解，同时减轻吻合口形成；65%紧急手术 vs 45%支架置入术作为手术桥梁（P＜0.001）。在3个月，12个月或者重症监护期间，QoL没有显著差异。可能治愈的患者1年死亡率根据治疗组不同而未有差异。
CREST: Randomised phase III study of stenting as a bridge to surgery in obstructing colorectal cancer—Results of the UK ColoRectal Endoscopic Stenting Trial (CREST).(Abstract3507)
Authors：James Hill, Clive Kay,et al
Session Type：Oral Abstract Session
Background: Uncertainty remains about the efficacy and safety of endoluminal stenting as an alternative to emergency surgery in patients with potentially curable obstructing left sided colorectal cancer. Emergency presentations still account for 20% of all colorectal cancer cases; obstruction is present in 80% of these.
Methods: Patients presenting in the emergency setting with left-sided colonic obstruction needing urgent decompression and radiological features of a carcinoma were randomized to either: endoluminal stenting as a bridge to surgery or surgical decompression. Patients were stratified according to curative intent based on pre-operative staging investigations. A combined endoscopic/fluoroscopic technique was standardized in stent workshops with elective surgery performed 1-4 weeks later.
Results: 246 patients from 39 units were randomized between 2009 and 2014 with 98% complying with allocated treatment. 92% were treated with curative intent. 30-day post-operative mortality (5.3% vs 4.4%) and length of hospital stay [15.5 days (IQR 10-26) vs 16 days (10-27)] were similar with stenting and surgery. Stenting achieved relief of obstruction in 82% of patients and reduced stoma formation; 69% emergency surgery v 45% with stenting as a bridge to surgery (p < 0.001). There were no significant differences in QoL at 3 and 12 months or critical care utilization. 1 year mortality for potentially curative patients did not differ by treatment group.
Conclusions: CReST is the largest trial of endoluminal stenting in obstructing colorectal cancer. In patients fit enough to undergo surgery, stenting as a bridge to surgery reduced stoma formation without a detrimental effect on one-year survival. Post-operative mortality, length of hospital stay, critical care usage and Quality of Life were not different between the two treatment groups. Clinical trial information: 13846816.