Outcome and Salvage Surgery Following "Watch and Wait" for Rectal Cancer after Neoadjuvant Therapy: A Systematic Review
Outcome and Salvage Surgery Following "Watch and Wait" for Rectal Cancer after Neoadjuvant Therapy: A Systematic Review
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DOI：
10.1097/dcr.0000000000000754
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发表时间：
2017-03-01
影响因子：
3.9
通讯作者：
Heriot, Alexander G.
中科院分区：
文献类型：
--
作者：
Kong, Joseph C.;Guerra, Glen R.;Heriot, Alexander G.
背景：目前还没有可靠的试验来预测直肠癌新辅助放化疗后的病理完全缓解。然而，越来越多的人对使用临床完全缓解作为替代标志物感兴趣，允许局部晚期直肠癌患者子集被分配到“观察和等待”途径。关于“观察和等待”方法的肿瘤安全性或肿瘤再生病例的抢救手术率知之甚少。这些信息对于实施这一方法至关重要。目的：本研究的目的是评估采用“观察和等待”方法发生肿瘤再生的患者的挽救性手术率和相关的肿瘤预后。数据来源：相关研究通过PubMed、Embase和谷歌Scholar检索得到。研究选择：根据PRISMA指南对选择“观察和等待”方法的患者进行系统评价。主要结局指标：评估相关肿瘤再生、挽救性手术、无病生存率和总生存率。结果：5项回顾性研究和4项前瞻性观察性研究纳入分析，“观察等待”组共370例患者，其中256例（69.2%）患者临床持续完全缓解。在肿瘤再生的患者中，抢救手术成功率为83.8%。在接受立即手术的患者和“观察等待”组之间，总生存期和无病生存期没有差异。局限性：本研究的局限性包括其回顾性和小样本量。此外，考虑到肿瘤再生和远处转移可能在较晚的时间点出现，研究方案之间存在显著的异质性，包括较短的中位随访。结论：绝大多数肿瘤再生患者在“观察、等待”后，可以通过明确的手术挽救。然而，没有足够的证据得出关于这种方法的肿瘤安全性的确切结论；因此，它目前不是局部晚期直肠癌的标准治疗方法。
BACKGROUND: Currently there is no reliable test to predict pathological complete response following neoadjuvant chemoradiotherapy for rectal cancer. However, there is increasing interest in using clinical complete response as a surrogate marker, allowing a subset of patients with locally advanced rectal cancer to be allocated into a "watch and wait" pathway. Little is known about the oncological safety of the" watch and wait" approach or the rate of salvage surgery in cases of tumor regrowth. This information is critical for the implementation of this approach.OBJECTIVE: The aim of this study is to assess the rate of salvage surgery and associated oncological outcomes for patients who develop a tumor regrowth with the "watch and wait" approach.DATA SOURCES: Relevant studies were identified through PubMed, Embase, and Google Scholar search.STUDY SELECTION: A systematic review was undertaken of studies assessing patients selected for the" watch and wait" approach according to PRISMA guidelines.MAIN OUTCOME MEASURES: The associated tumor regrowth, salvage surgery, and disease-free and overall survival rates were assessed.RESULTS: Five retrospective and 4 prospective observational studies were included into the analysis, with a total of 370 patients in the "watch and wait" group, of which 256 ( 69.2%) had persistent clinical complete response. Of those who had tumor regrowth, salvage surgery was possible in 83.8%. There was no difference in overall survival and disease-free survival between patients who received immediate surgery and the "watch and wait" group.LIMITATIONS: The limitations of this study include its retrospective nature and small sample size. Furthermore, there is significant heterogeneity between study protocols, including the short median follow-up, given that tumor regrowth and distant metastasis may manifest at a later time point.CONCLUSION: The majority of patients with tumor regrowth can be salvaged with definite surgery after "watch and wait." However, there is insufficient evidence to draw firm conclusions on the oncological safety of this approach; therefore, it is currently not the standard of care for locally advanced rectal cancer.