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Current and future cancer staging after neoadjuvant treatment for solid tumors.
文献信息
| DOI | 10.3322/caac.21640 |
|---|---|
| PMID | 33156543 |
| 期刊 | CA: a cancer journal for clinicians |
| 影响因子 | 232.4 |
| JCR 分区 | Q1 |
| 发表年份 | 2021 |
| 被引次数 | 35 |
| 关键词 | 癌症登记，癌症分期，临床分期，新辅助治疗，病理分期 |
| 文献类型 | Journal Article, Review |
| ISSN | 0007-9235 |
| 页码 | 140-148 |
| 期号 | 71(2) |
| 作者 | David R Byrd, James D Brierley, Thomas P Baker, Daniel C Sullivan, Donna M Gress |
一句话小结
本研究探讨了新辅助治疗（NAT）后癌症分期数据的重要性，指出目前癌症登记处尚未系统收集此类数据，可能导致对临床和病理发现的误解。通过乳腺癌、直肠癌和食管癌的实例，强调了标准化记录NAT后的临床反应和分期，以促进对治疗效果的群体评估，推动癌症管理的改进。
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癌症登记 · 癌症分期 · 临床分期 · 新辅助治疗 · 病理分期
摘要
直到最近，癌症登记处仅收集诊断时的癌症临床分期（在任何治疗之前）以及在外科切除后的病理分期（前提是手术前未进行任何治疗），但它们并未收集新辅助治疗（NAT）后的分期数据。由于NAT在治疗多种肿瘤中被越来越多地采用，因此区分NAT前的临床和病理评估与NAT后的评估变得尤为重要，以避免对临床和病理发现意义的误解。同时，癌症登记处在NAT后收集数据也很重要，以便在群体层面评估这种治疗方法的反应和有效性。前缀“y”用于表示NAT后的分期。目前，美国外科医师学会癌症委员会的癌症登记处仅部分收集y分期数据，且对NAT的临床反应（yc或治疗后临床信息）没有以标准化的方式进行收集或记录。除了NAT外，放疗和化疗后的非手术管理在直肠癌中也越来越频繁地使用，并可能扩展到其他治疗部位。通过乳腺癌、直肠癌和食管癌的实例，回顾了NAT后观察到的病理和影像学变化，以展示适当的分期。
英文摘要
Until recently, cancer registries have only collected cancer clinical stage at diagnosis, before any therapy, and pathological stage after surgical resection, provided no treatment has been given before the surgery, but they have not collected stage data after neoadjuvant therapy (NAT). Because NAT is increasingly being used to treat a variety of tumors, it has become important to make the distinction between both the clinical and the pathological assessment without NAT and the assessment after NAT to avoid any misunderstanding of the significance of the clinical and pathological findings. It also is important that cancer registries collect data after NAT to assess response and effectiveness of this treatment approach on a population basis. The prefix y is used to denote stage after NAT. Currently, cancer registries of the American College of Surgeons' Commission on Cancer only partially collect y stage data, and data on the clinical response to NAT (yc or posttherapy clinical information) are not collected or recorded in a standardized fashion. In addition to NAT, nonoperative management after radiation and chemotherapy is being used with increasing frequency in rectal cancer and may be expanded to other treatment sites. Using examples from breast, rectal, and esophageal cancers, the pathological and imaging changes seen after NAT are reviewed to demonstrate appropriate staging.
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主要研究问题
- 在不同类型的肿瘤中，如何具体评估新辅助治疗后的临床和病理分期？
- 新辅助治疗对肿瘤分期评估的影响有哪些，是否会影响治疗方案的选择？
- 目前癌症登记机构在收集新辅助治疗后分期数据方面存在哪些主要挑战？
- 如何改进癌症登记系统，以便更有效地记录新辅助治疗后的临床反应和分期信息？
- 除了乳腺癌、直肠癌和食管癌，其他哪些肿瘤类型的分期可能会受到新辅助治疗的影响？
核心洞察
研究背景和目的
近年来，针对多种肿瘤的治疗方案中，术前新辅助治疗（NAT）的使用逐渐增加。然而，癌症登记系统传统上仅收集诊断时的临床分期数据和手术切除后的病理分期数据，而未对NAT后的分期进行系统性收集。由于NAT对肿瘤的治疗效果显著，明确NAT前后的临床和病理评估差异显得尤为重要。本研究旨在探讨在NAT后如何有效地进行癌症分期，并推动癌症登记系统采集相关数据，以便更好地评估NAT的效果和反应。主要方法和发现
研究回顾了乳腺癌、直肠癌和食管癌等多种肿瘤在接受NAT后所表现出的病理和影像学变化。分析显示，NAT后临床和病理分期的评估（即y分期）与传统分期具有显著不同，这种差异影响了对治疗反应的理解。同时，当前美国癌症外科医师学会（ACoS）下属的癌症登记系统仅部分收集y分期数据，且缺乏标准化的后疗效临床信息（yc）的收录。核心结论
为了有效评估NAT的疗效和反应，癌症登记系统必须开始系统性地收集NAT后的分期数据（y分期）以及后疗效的临床信息。这不仅有助于更好地理解NAT对肿瘤的影响，还能避免在临床和病理评估中产生误解，从而为未来的临床决策提供更可靠的数据支持。研究意义和影响
本研究强调了在现代肿瘤治疗中，尤其是新辅助治疗的背景下，对癌症分期进行更全面、系统化收集的重要性。通过建立标准化的数据采集流程，不仅可以提高对治疗反应的评估准确性，还能为今后研究提供基础数据，促进癌症治疗方案的改进。此外，随着非手术管理策略在直肠癌等领域的扩大应用，研究结果还可能对其他治疗领域的临床实践产生深远影响，推动个体化医疗的发展。
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