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J Am Coll Surg：你知道直肠癌新辅助放化疗后多久做手术效果更佳吗？

2016-05-22 Seven L MedSci原创

直肠癌新辅助放化疗手术切除
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Zhifei Sun, Mohamed A. Adam,et al.Optimal Timing to Surgery after Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. J Am Coll Surg. 2016 Apr;222(4):367-7,

先前有证据表明，局部晚期直肠癌患者接受新辅助放化疗(nCRT)，有益于肿瘤体积的缩小，并改善患者长期的局部癌症控制情况。但是，患者完成新辅助放化疗后，应该间隔多长时间进行肿瘤切除术呢？间隔多长时间的手术才能最大限度的切除肿瘤、让病理降期呢？带着这个疑问杜克大学的研究者进行了一项研究。

该研究纳入了11760名II期和III期直肠腺癌患者，所有患者在接受nCRT后进行手术。最后一次放化疗时间到进行手术的时间，为研究中的“间隔时间”。该研究以手术切缘肿瘤细胞阳性与病理分期作为主要结局，此外研究者还评估了校正后间隔时间和研究终点的联系，并建立一个最佳的手术间隔时间阈值。

下图为间隔时间分布图，整体上患者的中位数间隔时间为53天（四分间距[IQR] 43-63天）。

下图显示了间隔时间（横轴）与手术切缘肿瘤细胞阳性风险和病理分期下调可能性的联系。校正人口统计学、临床、肿瘤和治疗特点后，间隔时间为56天时，患者术中肿瘤的完全切除率和病理分期下调的可能性最高。



下图显示的为以56天为最佳手术间隔时间阈值时，不同时间间隔对肿瘤和围生期结局的影响。



间隔时间超过56天的患者，切缘肿瘤细胞阳性风险增加(OR=1.40, 95% CI 1.21 - 1.61, p < 0.001)，病理分期下调的可能性下降(≥56天 vs. <56天, OR=1.12, 95% CI 1.02 - 1.23, p = 0.01)。

研究结果表明，局部晚期直肠癌患者新辅助放化疗后，间隔8周进行手术，可能是肿瘤最佳反应的临界阈值。

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    2016-12-11 zhouqu_8

    #辅助放化疗#

    0

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    2016-06-20 waiwai3030

    #Coll#

    0

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    2016-09-30 1e10c84am36(暂无匿称)

    拜读，好文

    0

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    2016-12-19 charl1234576

    #新辅助#

    0

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    2016-05-24 lisa439

    #新辅助放化疗#

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