对直肠癌新辅助治疗后等待观察策略医生认知和实践的现况再调查  

Reassessment of practice of Chinese surgeons since introduction of the watch and wait strategy after neoadjuvant therapy for rectal cancer

作　　者：赵鸣鹤 孙婷婷[1] 王林[1] 黄泳霖 谢星宇 卢云[3] 赵国华[4] 武爱文[1,5] Zhao Minghe;Sun Tingting;Wang Lin;Huang Yonglin;Xie Xingyu;Lu Yun;Zhao Guohua;Wu Aiwen(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Gastrointestinal Cancer Center,Unit Ill,Peking University Cancer Hospital&Institute,Beijing 100142,China;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Radiation Oncology,Peking University Cancer Hospital&Institute,Beijing 100191,China;Department of Gastrointestinal Surgery of Qingdao University Affiliated Hospital,Qingdao 266000,China;Department of General Surgery,Cancer Hospital of China Medical University,Shenyang 110042,China;State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers,Beijing Key Laboratory of Carcinogenesis and Translational Research,Gastrointestinal Cancer Center,Unit IIl,Peking University Cancer Hospital&Institute,Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心三病区,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]北京大学医学部,北京100191 [3]青岛大学附属医院胃肠外科,青岛266000 [4]中国医科大学肿瘤医院普通外科,沈阳110042 [5]消化系肿瘤整合防治全国重点实验室,恶性肿瘤转化研究北京市重点实验室,北京100142

出　　处：《中华胃肠外科杂志》2024年第4期383-394,共12页Chinese Journal of Gastrointestinal Surgery

基　　金：国家重点研发计划(2021YFF1201104);国家自然科学基金(82173156);扬帆计划-重点医学专业(ZYLX202116)。

摘　　要：目的了解中国外科医生对于直肠癌新辅助治疗后等待观察疗法的观点和治疗选择的现状。方法采用横断面调查方法进行问卷调查,通过"问卷星"网络调查平台创建关于直肠癌新辅助治疗后等待观察治疗中国外科医生的再认知和实践调查问卷。调查对象的选择标准:(1)全国范围内,有完善的结直肠癌诊疗资质的(省级或地市级)肿瘤专科医院或综合医院:(2)目标中心的副主任医师及以上的外科、放疗科或内科医生。2023年12月13日至16日,在CWWD微信群中发送调查问卷链接,共发送321份问卷。问卷总共32个问题,内容包括:(1)医生的基本信息(含手术量统计);(2)临床完全缓解(cCR)的评估方式及标准;(3)等待观察的适用人群;(4)促进cCR的新辅助治疗方式及其他措施;(5)等待观察的实施意愿及影响因素;(6)等待观察的风险与监测;(7)等待观察后续治疗及随访;(8)对于中国等待观察数据库(CWWD)的发展建议。总结上述调查结果,组间比较采用χ^(2)检验或Fisher确切概率法。结果共发送问卷321份,共收到101份反馈,应答率为31.5%,反馈对象来自全国23个省市自治区直辖市、70家中心。来自省级三甲医院的医生占比85.1%(86/101)。已开展等待观察治疗的医生占比87.1%(88/101)。肿瘤专科医院医生对等待观察策略的认可率(65.6%,21/32)和经常告知患者的比例(68.8%,22/32)均高于综合医院医生(27.7%,18/65;32.4%,22/68),差异均有统计学意义(χ^(2)=12.83,P<0.001;χ^(2)=11.70,P=0.001)。直肠指诊(90.1%,91/101)、结肠镜检查(91.1%,92/101)、直肠T2加权像核磁共振(86.1%,87/101)以及扩散加权成像磁共振(85.1%,86/101)是本次调查受访医生判断cCR最常用的诊断方式;cCR的判断标准包括:直肠指诊未触及肿物(87.1%,88/101)、内镜下扁平白色瘢痕及新生毛细血管(77.2%,78/101),直肠核磁T2序列未见明显肿瘤信号或T2WI低信号或与肠壁等信号(83.2%,84/101)、DWI无肿�Objective To investigate perspectives and changes in treatment selection by Chinese surgeons since introduction of the watch-and-wait approach after neoadjuvant therapy for rectal cancer.Methods A cross-sectional survey was conducted using a questionnaire distributed through the"Wenjuanxing"online survey platform.The survey focused on the recognition and practices of Chinese surgeons regarding the strategy of watch-and-wait after neoadjuvant therapy for rectal cancer and was disseminated within the China Watch-and-Wait Database(CWWD)WeChat group.This group targets surgeons of deputy chief physician level and above in surgical,radiotherapy,or internal medicine departments of nationally accredited tumor-specialist or comprehensive hospitals(at provincial or municipal levels)who are involved in colorectal cancer diagnosis and treatment.From 13 to 16 December 2023,321 questionnaires were sent with questionnaire links in the CwWD WeChat group.The questionnaires comprised 32 questions encompassing:(1)basic physician characteristics(including surgical volume);(2)assessment methods and criteria for clinical complete response(cCR);(3)patients eligible for watch-and-wait;(4)neoadjuvant therapies and other measures for achieving cCR;(5)willingness to implement watch-and-wait and factors influencing that willingness;(6)risks and monitoring of watch-and-wait;(7)subsequent treatment and follow-up post watch-and-wait;(8)suggestions for development of the CwwD.Descriptive statistics were employed for data analysis,with intergroup comparisons conducted using the x or Fisher's exact probability tests.Results The response rate was 31.5%,comprising 101 responses from the 321 individuals in the WeChat group.Respondents comprised 101 physicians from 70 centers across 23 provinces,municipalities,and autonomous regions nationwide,85.1%(86/101)of whom represented provincial tertiary hospitals.Among the respondents,87.1%(88/101)had implemented the watch-and-wait strategy.The approval rate(65.6%,21/32)and proportion of patients often infor

关 键 词：直肠肿瘤 新辅助治疗 临床完全缓解 病理完全缓解 等待观察策略 

分 类 号：R735.37[医药卫生—肿瘤]