病理诊断在直肠癌新辅助治疗后等待观察策略中的指导作用

Guiding significance of pathological diagnosis in watch and wait strategy for locally advanced rectal cancer patients after neoadjuvant therapy

研究表明,局部进展期直肠癌患者新辅助放化疗(nCRT)后,会发生临床完全缓解(cCR)。部分精心挑选的患者经等待观察后,获得很好的疗效。这种保留器官的方法,有助于患者避免手术及其相关的发病率和死亡率。nCRT会导致肿瘤细胞的退变和残留肿瘤细胞的不均匀分布。由于假阴性率高,活检的可靠性在等待观察策略中仍不尽如人意。因此,对病理组织学检查阴性的患者,也应严格随访。今后,免疫微环境和分子标记、源于患者的类器官培养、循环肿瘤细胞(CTC)和血浆游离DNA(cfDNA)等技术,可能有助于等待观察患者的筛查和监测。

Some studies have demonstrated promising results of watch and wait(W&W)approaches in carefully selected patients with locally advanced rectal cancer who get a clinical complete response(cCR)after neoadjuvant chemoradiotherapy(nCRT).This approach of organ-preservation helps patients avoid surgery and its related morbidity and mortality.nCRT will lead to the regression of the tumor cells and the uneven distribution of the residual tumor cells.The reliability of biopsy is still unsatisfactory in W&W strategy due to the high ratio of false negative cases.Therefore,the patients with negative histopathological assessment should also receive a strict follow-up.In the future,immune microenvironment and molecular markers,patient derived organoid,circulating tumor cells(CTCs)and circulating cell-free nucleic acids(cfDNA)may be helpful for screening and monitoring patients undergoing W&W.