拒绝手术开刀！这些癌症不消“挨刀”亦能实现治愈
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">对绝大<span style="color: black;">都数</span>实体瘤而言，要实现彻底治愈，最大的机会<span style="color: black;">便是</span><span style="color: black;">初期</span><span style="color: black;">发掘</span>，<span style="color: black;">而后</span>手术切除。<span style="color: black;">初期</span>的肺癌、乳腺癌、胃癌、肠癌、食管癌、肝癌、膀胱癌、肾癌、前列腺癌、卵巢癌、子宫内膜癌、宫颈癌、甲状腺癌<span style="color: black;">乃至</span>胰腺癌，手术彻底切除以后，临床治愈率都<span style="color: black;">能够</span>达到50%-70%以上，<span style="color: black;">乃至</span>更高。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">不外</span>，手术毕竟是有创伤的，<span style="color: black;">况且</span><span style="color: black;">亦</span>有<span style="color: black;">必定</span>的并发症，<span style="color: black;">例如</span>术中<span style="color: black;">流血</span>、感染、<span style="color: black;">麻木</span>意外等，<span style="color: black;">同期</span><span style="color: black;">有些</span><span style="color: black;">要紧</span>脏器的手术<span style="color: black;">亦</span>可能<span style="color: black;">引起</span><span style="color: black;">要紧</span>的生理功能的缺失，<span style="color: black;">例如</span>语言功能、排尿排便功能、消化吸收功能、味觉嗅觉等。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，<span style="color: black;">针对</span><span style="color: black;">初期</span>实体瘤<span style="color: black;">病人</span>，在不降低治愈率的前提下，<span style="color: black;">怎样</span>进一步保住<span style="color: black;">要紧</span>的生理功能，大幅度改善生活质量，是医学<span style="color: black;">科研</span>的重点。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">经<span style="color: black;">太多</span>年的改良和优化，以放疗为主的其他局部治疗手段，<span style="color: black;">协同</span>化疗、靶向治疗、免疫治疗等其他<span style="color: black;">药品</span>治疗，<span style="color: black;">日前</span><span style="color: black;">已然</span>越来越多地被证实，<span style="color: black;">能够</span>取得和手术切除类似的疗效。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">上周，国际权威的《胃肠病学》杂志<span style="color: black;">颁布</span>了一项前瞻性非随机对照临床<span style="color: black;">实验</span>结果，<span style="color: black;">针对</span>I期可手术切除的食管癌<span style="color: black;">病人</span>，放化疗的疗效不逊色于手术切除。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">咱们</span>都<span style="color: black;">晓得</span>食管一旦切除，会影响<span style="color: black;">病人</span>的消化吸收功能，<span style="color: black;">同期</span>食管癌根治术本身难度<span style="color: black;">很强</span>，短期内的并发症和死亡率其实并不算太低。同步放化疗虽然<span style="color: black;">亦</span>有不良反应（<span style="color: black;">重点</span>是化疗<span style="color: black;">引起</span>的恶心、呕吐、骨髓<span style="color: black;">控制</span>等），但毕竟<span style="color: black;">能够</span>保住食管，等急性期<span style="color: black;">有害</span>反应度过以后，后续<span style="color: black;">长时间</span><span style="color: black;">存活</span>以后，生活质量有望<span style="color: black;">加强</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">这项临床<span style="color: black;">实验</span>一共有368名<span style="color: black;">病人</span>入组，一组209人接受手术切除，另一组159人接受放化疗，接受手术这一组年龄更轻<span style="color: black;">有些</span>（中位年龄62岁对比65岁），其它基线特征都是类似且<span style="color: black;">平衡</span>的。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">结果<span style="color: black;">表示</span>：两组5年<span style="color: black;">存活</span>率分别是86.5%和85.5%，<span style="color: black;">无</span>统计学差异；手术组有2人死于手术并发症，放化疗组<span style="color: black;">无</span>病人死于放化疗的不良反应。</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-843378f6f5ccd8711da0cf2959b2da5a_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">其实除了食管癌，其他癌种里<span style="color: black;">亦</span>有<span style="color: black;">海量</span>类似的<span style="color: black;">科研</span>：<span style="color: black;">例如</span>I期的肺癌，手术和单纯的立体定向放疗，疗效和<span style="color: black;">存活</span>期<span style="color: black;">亦</span>相差<span style="color: black;">没</span>几。这方面的数据，咚咚科普过不少了，欢迎复习：<a style="color: black;"><span style="color: black;">初期</span>癌症<span style="color: black;">不消</span>开刀，<span style="color: black;">亦</span>能治愈：<span style="color: black;">办法</span>还不少</a></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">当然上面<span style="color: black;">说到</span>的都是I期这种非常<span style="color: black;">初期</span>的癌症，<span style="color: black;">针对</span>II期、III期这种中期<span style="color: black;">乃至</span>中晚期的病人，<span style="color: black;">可否</span><span style="color: black;">亦</span>有类似的案例呢。当然是有的，尤其是低位直肠癌<span style="color: black;">病人</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">日前</span>的<span style="color: black;">科研</span><span style="color: black;">表示</span>，<span style="color: black;">经过</span><span style="color: black;">恰当</span>的放化疗，<span style="color: black;">能够</span>让大约20%-30%的中晚期直肠癌<span style="color: black;">病人</span>实现临床<span style="color: black;">道理</span>上的完全缓解，<span style="color: black;">亦</span><span style="color: black;">便是</span><span style="color: black;">经过</span><span style="color: black;">各样</span>影像学（CT、<span style="color: black;">彩超</span>、PET-CT、MRI等）以及胃肠镜均<span style="color: black;">没</span>法<span style="color: black;">发掘</span><span style="color: black;">知道</span>的癌细胞存在。<span style="color: black;">针对</span>这些实现了临床完全缓解的病人，经过精心挑选，其中一部分病人是<span style="color: black;">能够</span>避免手术，保住肛门等<span style="color: black;">要紧</span>器官，实现生理功能完好前提下的<span style="color: black;">长时间</span><span style="color: black;">存活</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">2021年年初，《柳叶刀.肿瘤学》杂志就<span style="color: black;">颁布</span>过一项由欧洲多国<span style="color: black;">专家</span><span style="color: black;">一块</span>主导的国际多中心队列<span style="color: black;">科研</span>数据：15个国家47所顶尖癌症中心，一共汇总了739名放化疗后达到临床完全缓解的中晚期直肠癌<span style="color: black;">病人</span>，<span style="color: black;">选取</span><span style="color: black;">所说</span>的“观察等待”、不着急手术的战略之后的<span style="color: black;">长时间</span>疗效数据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">中位随访55.2个月，结果<span style="color: black;">发掘</span>：5年后依然有72.1%的<span style="color: black;">病人</span>保持<span style="color: black;">没</span>瘤<span style="color: black;">存活</span>，真正<span style="color: black;">显现</span><span style="color: black;">疾患</span>反弹复发的病人不足30%；而<span style="color: black;">哪些</span><span style="color: black;">显现</span><span style="color: black;">疾患</span>复发的病人，<span style="color: black;">都数</span>是局部复发，依然有手术机会。5年内<span style="color: black;">显现</span>远处转移，从而失去手术机会的病人，其实<span style="color: black;">仅有</span>11.1%。<span style="color: black;">另外</span>：</p><span style="color: black;">哪些</span>观察等待1年，还<span style="color: black;">无</span><span style="color: black;">显现</span>肿瘤反弹的病人，<span style="color: black;">将来</span>2年后依然会有88.1%的病人保持<span style="color: black;">没</span>瘤状态；<span style="color: black;">哪些</span>观察等待3年，还<span style="color: black;">无</span><span style="color: black;">显现</span>肿瘤反弹的病人，<span style="color: black;">将来</span>2年后依然会有97.3%的病人保持<span style="color: black;">没</span>瘤状态；<span style="color: black;">哪些</span>观察等待5年，还<span style="color: black;">无</span><span style="color: black;">显现</span>肿瘤反弹的病人，<span style="color: black;">将来</span>2年后依然会有98.6%的病人保持<span style="color: black;">没</span>瘤状态。<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic4.zhimg.com/80/v2-5c489e98ab47133df044a1a13e9a1877_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">综上所述，近年来<span style="color: black;">因为</span>放疗、<span style="color: black;">药品</span>治疗等手段的<span style="color: black;">持续</span>进步，越来越多的早中期实体瘤<span style="color: black;">病人</span>，有机会在手术治疗之外，找到一种全新的治疗<span style="color: black;">选取</span>，从而保留<span style="color: black;">要紧</span>器官功能，<span style="color: black;">况且</span>保持较高的临床治愈率。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">参考文献：</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">. KenKato, Yoshinori Ito, Isao Nozaki , et al. Parallel-group controlled trial ofsurgery versus chemoradiotherapy in patients with stage I esophageal squamouscell carcinoma.Gastroenterology. 2021 Aug 10;S0016-5085(21)03352-7.</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">. RobertD Timmerman, Rebecca Paulus, Harvey I Pass, et al. Stereotactic Body RadiationTherapy for Operable Early-Stage Lung Cancer: Findings From the NRG OncologyRTOG 0618 Trial.JAMA Oncol. 2018 Sep 1;4(9):1263-1266</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">. LauraM Fernandez, Guilherme P São Julião , Nuno L Figueiredo, et al. Conditionalrecurrence-free survival of clinical complete responders managed by watch andwait after neoadjuvant chemoradiotherapy for rectal cancer in the InternationalWatch & Wait Database: a retrospective, international, multicentre registrystudy.LancetOncol2021 Jan;22(1):43-50.</p>
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