基于局部晚期直肠癌的初始TNM阶段和肿瘤大小的肿瘤反应率：共享决策的有用工具
Tumor response rates based on initial TNM stage and tumor size in locally advanced rectal cancer: a useful tool for shared decision-making
影响因子:2.90000
分区:医学3区 / 胃肠肝病学3区 外科3区
发表日期:2024 Sep 10
作者:
M Boubaddi, C Fleming, V Assenat, M-O François, E Rullier, Q Denost
摘要
人们认为，肿瘤阶段和大小可以影响局部晚期直肠癌（LARC）中对新辅助治疗的反应。迄今为止，有关器官保存的研究包括各种大小和TNM阶段肿瘤。这项研究的目的是报告基于每个相关TNM阶段和肿瘤大小的肿瘤反应。从2014年到2021年，LARC的患者使用CT2-3NXM0肿瘤治疗，这些肿瘤包括接受新辅助化学疗法，包括或没有诱导化学疗法。在诊断时（CTNM）上分级肿瘤，并根据骨盆MRI计算肿瘤大小。肿瘤大小基于每个肿瘤最长轴的最大维度。进行临床反应是根据治疗后骨盆MRI和手术后的病理反应定义的。使用IBM SPSS Statistics™进行统计分析，版本20。分析了432名患者的数据如下：CT2N0（n = 51），CT2N+（n = 36），CT3N0（n = 76）（n = 76），CT3N+（ct3n+（n = 270）。与完整响应的速率（ccr或ncr）的速率（ccr或ncr）vried（ccr ccr ccr ccr ccr ccr ccr ccr ccr ccr verife的率很高） CT3N+> 4厘米的20％。 86％的CT2N0患者，CT2N+的50％，CT3N0中的39％，CT3N+的39％在2年中无复发，在CT3N+中实现了50％。肿瘤反应似乎与增加TNM期和肿瘤大小成反比。这些数据既可以支持选择性的患者招募到器官保存计划，又可以支持共同的决策。
Abstract
It is accepted that tumor stage and size can influence response to neoadjuvant therapy in locally advanced rectal cancer (LARC). Studies on organ preservation to date have included a wide variety of size and TNM stage tumors. The aim of this study was to report tumor response based on each relevant TNM stage and tumor size.Patients treated with LARC from 2014 to 2021 with cT2-3NxM0 tumors who received neoadjuvant chemoradiotherapy with or without induction chemotherapy were included. Tumors were staged and tumor size calculated on pelvic MRI at the time of diagnosis (cTNM). Tumor size was based on the largest dimension taken on the longest axis of each tumor. Clinical response was defined on the basis of post-treatment pelvic MRI and pathological response following surgery, when performed. Statistical analysis was performed using IBM SPSS Statistics™, version 20. Data from 432 patients were analyzed as follows: cT2N0 (n = 51), cT2N+ (n = 36), cT3N0 (n = 76), cT3N+ (n = 270).The rate of complete or near-complete response (cCR or nCR) varied from 77% in cT2N0 ≤ 3 cm to 20% in cT3N+ > 4 cm. Organ preservation without recurrence at 2 years was achieved in 86% of patients with cT2N0, 50% in cT2N+, 39% in cT3N0, and 12% in cT3N+.There is significant variation in tumor response according to tumor stage and size. Tumor response appears inversely proportional to increasing TNM stage and tumor size. This data can support both refinement of selective patient recruitment to organ preservation programs and shared decision-making.