Background: Survival data on patients with locally advanced rectal cancer (LARC) undergoing non-operative management (NOM) in a real-world setting are lacking. Methods: We analyzed LARC patients from the National Cancer Database with the following features: treated between 2010 and 2020, age 18–65 years, Charlson comorbidity index (CCI) ≤ 1, received neoadjuvant multiagent chemotherapy plus radiation ≥ 45 Gray, and underwent surgery or NOM. Patients were stratified into two groups: (A) clinical T1-3 tumors with positive nodes (cT1-3N+) and (B) clinical T4 tumors, N+/− (cT4N+/−). We performed a comparative analysis of overall survival (OS) with NOM versus surgery by the Kaplan–Meier method and propensity score matching. Additionally, a multivariable analysis explored the association between NOM and OS. Results: NOM exhibited significantly lower OS than surgery in both groups. In cT1-3N+ patients, NOM resulted in a 5-year OS of 73.9% (95% confidence interval [CI] = 69.7–77.6%) versus 84.5% (95% CI = 83.6–85.3%) with surgery (p< 0.001). In the cT4N+/− group, NOM yielded a 5-year OS of 44.5% (95% CI = 37.0–51.8%) versus 72.5% (95% CI = 69.9–74.8%) with surgery (p< 0.001). Propensity score matching and multivariable analyses revealed similar conclusions. Conclusion: Patients with LARC undergoing NOM versus surgery in real-world settings appear to have inferior survival.
背景：目前缺乏关于局部晚期直肠癌患者在真实世界环境下接受非手术治疗生存情况的数据。方法：我们从国家癌症数据库中筛选2010年至2020年间接受治疗、年龄18-65岁、查尔森合并症指数≤1、接受≥45戈瑞新辅助多药化疗联合放疗、并接受手术或非手术治疗的局部晚期直肠癌患者。将患者分为两组：(A)临床T1-3期伴淋巴结阳性肿瘤(cT1-3N+)；(B)临床T4期肿瘤，无论淋巴结状态(cT4N+/-)。采用Kaplan-Meier法和倾向评分匹配比较非手术治疗与手术患者的总生存期差异，并通过多变量分析探讨非手术治疗与总生存期的关联。结果：两组中非手术治疗患者的总生存期均显著低于手术治疗组。在cT1-3N+患者中，非手术治疗的5年总生存率为73.9%（95%置信区间=69.7-77.6%），而手术治疗为84.5%（95%置信区间=83.6-85.3%）（p<0.001）。在cT4N+/-组中，非手术治疗的5年总生存率为44.5%（95%置信区间=37.0-51.8%），手术治疗为72.5%（95%置信区间=69.9-74.8%）（p<0.001）。倾向评分匹配和多变量分析得出相似结论。结论：在真实世界环境中，接受非手术治疗的局部晚期直肠癌患者相较于手术治疗患者生存结局较差。
肿瘤(癌症)患者之家