早期直肠癌症全新辅助治疗的器官保存：一项全州范围的分析
Organ preservation with total neoadjuvant therapy in early-stage rectal cancer: A statewide analysis.
摘要(中文译文)
早期（cT2-3N0）直肠腺癌的标准治疗是直接行全直肠系膜切除术（TME），但出于器官保留的需求，新辅助治疗在这些患者中的应用日益增多。由于其可能具有更高的完全缓解率，全程新辅助治疗（TNT）是一种有吸引力但研究不足的选择。本研究旨在确定接受TNT的早期直肠癌患者的结局。这是一项回顾性研究，纳入2019年至2025年在南澳大利亚接受TNT而非直接手术的cT2-3N0M0直肠腺癌患者。TNT包括长程放化疗，随后最多8个周期的FOLFOX或6个周期的CAPOX。达到临床完全缓解（cCR）的患者接受观察等待（W&W）监测。关注的结局包括cCR率、再生长率、局部复发和远处复发（LR和DR）以及3年生存率。共纳入39例患者，肿瘤距肛缘平均距离为4 cm。中位随访时间为41个月（IQR 26-61），53.8%的患者完成了至少3年的随访。31例患者（79.5%）达到cCR并进入W&W。再生长率为16.1%；无一例发生LR，3例发生DR。整个队列的3年无病生存（DFS）率为94.1%（95% CI 86.3%-100%），所有患者在3年随访时均存活。3级或以上化疗相关毒性发生率为25.6%，无死亡病例。接受TNT治疗的早期直肠癌患者具有极高的cCR率和相关的高器官保留率。与手术相比，该方法具有潜在的生活质量优势，且肿瘤学和毒性特征可接受。
Abstract
The standard treatment for early-stage (cT2-3N0) rectal adenocarcinoma is upfront Total Mesorectal Excision (TME), but the desire for organ preservation has seen the increasing use of neoadjuvant therapy in these patients. Owing to its likely higher complete response rate, Total Neoadjuvant Therapy (TNT) is an attractive but understudied option. This study aimed to determine outcomes in patients with early-stage rectal cancer undergoing TNT. This was a retrospective study of patients with cT2-3N0M0 rectal adenocarcinoma who underwent TNT instead of upfront surgery from 2019 to 2025 in South Australia. TNT comprised long-course chemoradiotherapy followed by up to 8 cycles of FOLFOX or 6 cycles of CAPOX. Patients with cCR were offered watch and wait (W&W) surveillance. The outcomes of interest included cCR rate, regrowth rate, local and distant recurrences (LR and DR) and 3-year survival. Thirty-nine patients were included, with mean tumour distance 4 cm from the anal verge. The median follow-up was 41 months (IQR 26-61) and 53.8% had completed at least 3 years of follow-up. Thirty-one patients (79.5%) achieved a cCR and proceeded to W&W. The regrowth rate was 16.1%; none experienced a LR and three had a DR. The 3-year DFS in the overall cohort was 94.1% (95% CI 86.3%-100%) and all patients were alive up to 3 years of follow-up. The rate of Grade 3 or higher chemotherapy-related toxicity was 25.6% and there were no deaths. Patients receiving TNT for early-stage rectal cancer had a very high cCR rate and associated high organ preservation rate. This approach has potential quality of life advantages compared with surgery, with acceptable oncological and toxicity profiles.
如何引用
AMA
Zachary Bunjo, Tracy Fitzsimmons, Thuy-My Nguyen, Michael Penniment, Sudarshan Selva-Nayagam, Darren Tonkin, et al. Organ preservation with total neoadjuvant therapy in early-stage rectal cancer: A statewide analysis.. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. 2026; doi:10.1111/codi.70446.
APA
Zachary Bunjo, Tracy Fitzsimmons, Thuy-My Nguyen, Michael Penniment, Sudarshan Selva-Nayagam, Darren Tonkin, et al (2026). Organ preservation with total neoadjuvant therapy in early-stage rectal cancer: A statewide analysis.. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. https://doi.org/10.1111/codi.70446
GB/T 7714
Zachary Bunjo, Tracy Fitzsimmons, Thuy-My Nguyen, Michael Penniment, Sudarshan Selva-Nayagam, Darren Tonkin, et al. Organ preservation with total neoadjuvant therapy in early-stage rectal cancer: A statewide analysis.[J]. Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2026 doi:10.1111/codi.70446.
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