NEJM:循环肿瘤DNA分析用于II期结肠癌患者术后治疗方案决策

2022-06-19 zhangfan MedSci原创

对于II期结肠癌患者,术后接受循环肿瘤DNA指导的辅助治疗可减少不必要化疗的使用,且不影响患者无复发生存率。

全球范围内结直肠癌发病率较高,目前非转移性结肠癌的标准治疗方案是手术,术后根据组织病理学分期需要进行长达6个月的辅助化疗。辅助化疗对III期结肠癌患者预后有益,但对II期患者的有效性仍存在争议。研究发现,手术就能治愈80%以上的II期结肠癌患者,但对于临床病理特征高风险的II期结肠癌患者仍考虑辅助化疗,因此如何准确定义“高风险”人群十分关键。术后循环肿瘤DNA(ctDNA)阳性人群通常无复发生存率较低,反之患者复发风险较低。近日研究人员考察了结肠癌术后ctDNA阳性患者辅助化疗的收益。

DYNAMIC研究中,研究人员考察了以ctDNA为指标,在不影响复发风险的情况下减少辅助化疗使用的可能性。II期结肠癌患者参与研究,随机根据ctDNA结果或标准临床病理特征进行治疗决策。对于ctDNA指导治疗组,术后4周或7周的ctDNA阳性人群接受奥沙利铂或氟脲嘧啶基础化疗。ctDNA阴性的患者不接受化疗。研究的主要疗效终点为2年无复发生存率,次要终点是辅助化疗的使用。

455名患者参与研究,其中ctDNA组302名,标准临床病理特征组153名,中位随访时间为37个月。ctDNA指导组接受辅助化疗的患者比例低于标准管理组(15% vs 28%;相对风险,1.82)。在2年无复发生存率评估中,ctDNA指导组不劣于标准治疗组(93.5% vs 92.4%;绝对差异为1.1%)。接受辅助化疗的ctDNA阳性患者三年无复发生存率为86.4%,未接受辅助化疗的ctDNA阴性患者三年无复发生存率为92.5%。

组间预后差异不显著

研究认为,对于II期结肠癌患者,术后接受循环肿瘤DNA指导的辅助治疗可减少不必要化疗的使用,且不影响患者无复发生存率。

 

原始出处:

Jeanne Tie et al. Circulating Tumor DNA Analysis Guiding Adjuvant Therapy in Stage II Colon Cancer. N Engl J Med,June 16, 2022.

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    2022-07-28 1235bd28m70暂无昵称

    认真学习了

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    2022-06-28 1235bd28m70暂无昵称

    认真学习了

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    2022-06-16 小元

    NEJM上果然牛,感谢梅斯更新及时

    0

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