青年与中老年进展期直肠癌患者新辅助放疗后的临床病理学比较研究

Comparison of pathologic and clinical characteristics of young and old patients with advanced rectal cancer after neoadjuvant radiotherapy

目的 研究青年与中老年进展期直肠癌患者新辅助放疗后的临床病理学差异及其对预后的影响.方法 收集分析252例于2000年1月至2005年1月接受开腹根治性手术的进展期直肠癌患者的临床病理资料.根据患者年龄分为青年组（＜40岁）和中老年组（≥40岁）,比较两组患者新辅助放疗后肿瘤病理与临床预后方面的差异,并研究两组肿瘤降期率与局部复发情况.结果 252例患者中,青年组54例、中老年组198例,两组患者性别、治疗前肿瘤临床分期、治疗前CEA水平的差异无统计学意义.青年组黏液腺癌及印戒细胞癌的比例、ⅢA期以上的比例均显著高于中老年组（P＜0.05）.青年组接受新辅助放疗者与未接受新辅助放疗者的局部复发率差异无统计学意义,而中老年组接受新辅助放疗者的局部复发率显著低于未接受新辅助放疗者（3.3%比11.2%,P＜0.05）.两组的术后5年无病生存率（63.3%比68.5%,P＞0.05）和总生存率（73.5%比72.9%,P＞0.05）差异均无统计学意义.结论 青年人直肠癌与中老年人直肠癌根治性手术后远期生存率无明显差别 新辅助放疗对青年人直肠癌的局部控制作用尚待明确.

Objectives To address the difference of pathologic and clinical characteristics of the young and the middle-aged and elderly patients with advanced rectal cancer after neoadjuvant radiotherapy. Methods A total of 252 patients undergoing radical surgery from January 2000 to January 2005 were included in this study. The patients were divided into two groups according to the age at diagnosis：young-patient group （ 〈40 years） and old-patient group （ ≥40 years）. The pathologic and clinical materials were collected and the oncologic outcome was compared between the two arms. Results A total of 252 patients were included in this study, included 54 patients in young-patient group and 198 patients in old-patient group, respectively. There was no significant difference in gender, clinical stage and pretreatment serum carcinoembryonic antigen （CEA） between the two groups. However, the proportion of mucinous and signet-ring cell cancer was significantly higher in young-patient group （20. 4% vs. 4.0%, P 〈0. 05）, and furthermore, the proportion of pathologic stage later than Ⅲ A was also significantly higher in the youngpatient group（61.1% vs. 42. 9% ,P 〈 0. 05 ）. There was no significant difference in local recurrence rate between the patients who received neoadjuvant radiotherapy and those who did not in the young-patient group, whereas the difference was observed significant in the old-patient group （3. 3% vs. 11.2%, P 〈0. 05）. There was no significant difference in both the disease free survival and overall survival between the two arms（5y-DFS：63.3% vs. 68.5% , P〉0. 05 5y-OS： 73.5% vs. 72.9% , P〉0. 05）. Conclusions Rectal cancer in young patients has poorer histologic differentiation and more advanced pathologic stage, but the long-term survival is similar to that in middle-aged and elderly patients. The local control effect of neoadjuvant radiotherapy on rectal cancer in young patients still need to be further investigated.