Outcomes of Postchemoradiotherapy Watch-and-Wait Strategy in Patients With Rectal Cancer: A 20-Year, Single-Center Study.

IF 2 3区 医学 Q3 ONCOLOGY
Shuo-Fu Chen, Shung-Haur Yang, Jeng-Kai Jiang, Ling-Wei Wang
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引用次数: 0

Abstract

Background and objectives: The watch-and-wait (WW) strategy is a nonsurgical alternative for patients with rectal cancer exhibiting an excellent response to chemoradiotherapy. Studies on the WW strategy have primarily investigated 5-year oncological outcomes; few have focused on longer-term outcomes or the optimal patient selection approach for this therapeutic strategy.

Methods: This retrospective study enrolled patients with locally advanced rectal adenocarcinoma who had achieved complete response after chemoradiotherapy. Patients who achieved pathological complete response were categorized into a control group (n = 95) and those who achieved clinical complete response and were managed using the WW strategy were categorized into a case group (n = 33). Kaplan-Meier estimates were calculated for the between-group comparison of survival.

Results: The median follow-up duration was 89 months. Compared with the control group, the case group exhibited improved long-term sphincter preservation, particularly for low-lying tumors (p = 0.032), and inferior nonlocal-regrowth disease-free survival (p = 0.007). Within the case group, patients achieving a complete response by positron emission tomography exhibited 5-year survival rates similar to those achieving a complete endoscopic response.

Conclusion: The WW strategy is associated with improved sphincter preservation but worse nonlocal-regrowth disease-free survival. The potential of PET in patient selection for this strategy deserves further investigation.

直肠癌患者放化疗后观察和等待策略的结果:一项20年的单中心研究
背景和目的:观察和等待(WW)策略是对放化疗有良好反应的直肠癌患者的一种非手术选择。WW策略的研究主要是研究5年的肿瘤预后;很少有人关注这种治疗策略的长期结果或最佳患者选择方法。方法:本回顾性研究纳入了局部晚期直肠癌患者,这些患者在放化疗后完全缓解。达到病理完全缓解的患者分为对照组(n = 95),达到临床完全缓解并采用WW策略的患者分为病例组(n = 33)。Kaplan-Meier估计用于组间生存率比较。结果:中位随访时间为89个月。与对照组相比,病例组表现出更好的长期括约肌保存,特别是对于低处肿瘤(p = 0.032),以及较差的非局部再生无病生存率(p = 0.007)。在病例组中,通过正电子发射断层扫描获得完全缓解的患者显示出与获得完全内镜缓解的患者相似的5年生存率。结论:WW策略与括约肌保存改善相关,但与非局部再生无病生存率差相关。PET在患者选择上的潜力值得进一步研究。
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来源期刊
CiteScore
4.70
自引率
4.00%
发文量
367
审稿时长
2 months
期刊介绍: The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.
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