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| 1 | 直肠癌放化疗后观察等待与手术治疗的配对队列研究显示文摘目的近年对于直肠癌放化疗后临床完全缓解的患者出现了新的治疗模式。这类患者在新辅助治疗后不进行手术治疗而进行观察-等待(watch-and-wait)的随诊观察。本研究旨在通过对比放化疗后临床完全缓解的患者接受手术治疗和观察-等待方式两者的肿瘤学转归,研究观察-等待随诊方式的安全性。方法 On Co Re(直肠癌完全缓解病例肿瘤学转归)研究是在英国曼切斯特一所三级癌中心进行的配对队列研究。自2011年1月到2013年4月,收集所有年龄段、无远处转移且接受了术前化放疗(45Gy,25天,同期氟尿嘧啶化疗)的直肠腺癌病例。达到临床完全缓解的患者,进入观察-等待方式,而未获临床完全缓解的患者,在条件允许下接受手术治疗。本研究通过注册登记,同时纳入自2005年3月10日至2015年1月21日来自相邻区域的3所英国癌中心临床完全缓解而接受单纯等待-观察方式的直肠癌患者。研究采用采用1∶1配比队列,使用倾向得分匹配分析法(包括T分期、年龄和体力状态),比较患者接受单纯观察等待与手术切除的治疗转归。主要观察终点为自化放疗开始后无疾病进展生存,次要终点为总体生存以及结肠造口术后无瘤生存。本研究以更保守的P〈0.01视为差异具有统计学意义。结果共有259例患者来自曼彻斯特癌中心,228例接受手术治疗,而31例临床完全缓解患者单纯进行观察-等待。此外通过注册登记的98例患者也进入观察-等待组。观察-等待组共129位患者[中位随访33个月(IQR 19~43个月)],44例(34%)局部复发。41例无转移的局部复发患者中36例(88%)接受了补救性手术。配对分析显示(各109例),观察-等待组和手术组的3年无疾病进展生存无统计学差异[88%(95%CI 75~94)vs.78%(63~87),P=0.043]。同时3年总体生存也没有显著性差异(96%vs.87%,P=0.024)。观察-等待组的结肠造口率明显低于手术组,其3年结肠造口术后无瘤生存率为74%(95%CI 64~82),而手术组为47%(P〈0.0001)。风险比0.445(95%CI 0.31~0.63,P〈0.0001),观察-等待组较手术组的3年终生造口风险降低26%(95%CI 13~39)。结论本研究显示,确实存在一定比例的直肠癌患者可以通过观察-等待方式避免手术,免除终生造口,同时获得3年良好的肿瘤安全性。这结果提示,应从一开始就认真考虑直肠癌患者化放疗策略,观察-等待治疗作为标准治疗方式看来是可行的。研究者认为如果患者在化放疗开始后,少于14周内取得早期临床完全缓解,或者大于24周取得临床完全缓解,其复发的机会较少。此外,广泛使用45 Gy的放疗的患者的临床完全缓解率为10%~15%,更高剂量的放化疗能够将其提高到大于50%。如此高的临床完全缓解率如果能够在可接受的毒副作用范围内反复出现,那么以上两种策略就可以实现长期、持续的临床完全缓解。然而,这一观察结果还需要临床研究验证。 | Renehan AG Malcomson L Emsley R 张信华 | 2016 | 消化肿瘤杂志(电子版)2016，8，1： | 27 |
| 2 | 在结肠和直肠的癌症的淋巴节点收获: 当前的考虑显示文摘 The prognostic significance of identifying lymph node(LN) metastases following surgical resection for colon and rectal cancer is well recognized and is reflected in accurate staging of the disease.An established body of evidence exists,demonstrating an association between a higher total LN count and improved survival,particularly for node negative colon cancer.In node positive disease,however,the lymph node ratios may represent a better prognostic indicator,although the impact of this on clinical treatment has yet to be universally established.By extension,strategies to increase surgical node harvest and/or laboratory methods to increase LN yield seem logical and might improve cancer staging.However,debate prevails as to whether or not these extrapolations are clinically relevant,particularly when very high LN counts are sought.Current guidelines recommend a minimum of 12 nodes harvested as the standard of care,yet the evidence for such is questionable as it is unclear whether an increasing the LN count results in improved survival.Findings from modern treatments,including down-staging in rectal cancer using pre-operative chemoradiotherapy,paradoxically suggest that lower LN count,or indeed complete absence of LNs,are associated with improved survival;implying that using a specific number of LNs harvested as a measure of surgical quality is not always appropriate.The pursuit of a sufficient LN harvest represents good clinical practice;however,recent evidence shows that the exhaustive searching for very high LN yields may be unnecessary and has little in? uence on modern approaches to treatment. | James R McDonald Andrew G Renehan Sarah T O’Dwyer Najib Y Haboubi | 2012 | World Journal of Gastrointestinal Surgery2012，4，1： | 8 |
| 3 | Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies显示文摘 | Andrew G Renehan Margaret Tyson Matthias Egger Richard F Heller Marcel Zwahlen | 2008 | The Lancet2008，，9612： | 2 |
| 4 | Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies显示文摘 | Andrew G Renehan Margaret Tyson Matthias Egger Richard F Heller Marcel Zwahlen | 2008 | The Lancet . 2008 (9612)2008，，： | 2 |
| 5 | Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies显示文摘 | Andrew G Renehan Margaret Tyson Matthias Egger Richard F Heller Marcel Zwahlen | 2008 | 2008 (9612)2008，，9612： | 2 |
| 6 | Body-mass in dex and incidence of cancer: a systematic review and meta analysis of prospective observational studies 显示文摘 | Renehan A G Tyson M Egger M etal | 2008 | Lancet2008，371，9612： | 1 |
| 7 | Clinico- pathological and treatment-related factors influencing survival in parotid cancer显示文摘 | Renehan AG Gleave EN Slevin N J | 1999 | Br J Cancer1999，80，12： | 1 |
| 8 | Extracapsular dissection for clinically benign parotid lumps: reduced morbidity without oncological compromise显示文摘 | McGurk M Thomas BL Renehan AC | 2003 | Br J Cancer2003，89，9： | 1 |
| 9 | Body-mass index and incidence of of cancer:a systematic review and meta-analysis of prospective observa- tional studied显示文摘 | Renehan AG Tyson M Egger M | 2008 | Lancet2008，371，： | 1 |
| 10 | Insulin-like growth fac- tor (IGF) -I, IGF binding protein-3, and cancer risk : systematic re- view and meta-regression analysis 显示文摘 | Renehan AG Zwahlen M Minder C | 2004 | Lancet2004，363，9418： | 1 |
| 11 | Bodymass index and incidence of cancer: a systematic review and recta-analysis of prospective observational studies 显示文摘 | Renehan AG Tyson M Egger M | 2008 | Lancet2008，371，： | 1 |
| 12 | Clinical significance of the tumour capsule in the treatment of parotid pleomorphie adenomas 显示文摘 | McGurk M Renehan A Gleave EN | 1996 | Br J Surg1996，83，12： | 1 |
| 13 | Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies显示文摘 | Renehan A G Tyson M Egger M Heller R F Zwahlen M | 2008 | Lancet2008，371，： | 1 |
| 14 | Clinical significance of the tumour capsule in the treat- ment of parotid pleomorphic adenomas显示文摘 | MCGURK M RENEHAN A GLEAVE E N | 1996 | Br J Surg1996，83，： | 1 |
| 15 | Stem cells : the intestinal stem cell as a paradigm 显示文摘 | Bach SP Renehan AG Potten CS | 2000 | Carcinogenesis2000，21，3： | 1 |
| 16 | Biological mechanisms linking obesity and cancer risk: new perspectives 显示文摘 | Roberts DL Dive C Renehan AG | 2010 | Annu RevMed2010，61，： | 1 |
| 17 | Obesity and cancer risk: the role of the insulin-IGF axis 显示文摘 | Renehan AG Frystyk J Flyvbjerg A | 2006 | Trends Endocrinol Metab2006，17，： | 1 |
| 18 | Impact on survival of intensive follow up after curative resection for colorectal cancer:systematic review and meta-analysis of randomized trials显示文摘 | Renehan A G Egger M Saunders M P | 2002 | Br Med J2002，324，： | 1 |
| 19 | Body-mass index and in- cidence of cancer: a systematic review and recta-analysis of pro- spective observational studies 显示文摘 | Renehan AG Tyson M Egger M | 2008 | Lancet2008，371，9612： | 1 |
| 20 | Insulin-like growth factor(IGF)-I, IGF binding protein-3, and cancer risk: systematic review and meta-regression analysis 显示文摘 | Renehan AG Zwahlen M Minder C | 2004 | Lancet2004，363，9418： | 1 |
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