低位直肠癌根治术后髂内动脉辅助化疗的临床研究

Radical resection for low rectal carcinoma combined with infusion pump chemotherapy via internal iliac artery

目的评价低位直肠癌根治术后置泵灌注化疗的疗效,探讨其临床应用价值,并对影响疗效的相关因素进行分析。方法回顾性分析1997年10月-2008年3月在解放军309医院接受手术治疗的低位直肠癌患者316例,根据根治术后采用的不同化疗方法分为两组:A组(手术加置泵组)249例,在直肠癌根治术中于髂内动脉置入化疗泵,术后行靶区灌注化疗及全身静脉化疗;B组(手术组)67例,行直肠癌根治术,仅在术后接受全身静脉化疗。A组靶区灌注化疗开始时间为术后12d胃肠功能恢复后,方案为氟尿嘧啶(0.5g/次)+羟喜树碱(10～15mg/次),每周2次,4次为1个疗程,共6个疗程。A组灌注化疗后行全身静脉化疗,采用FOLFIRI或FOLFOX方案,B组术后12d胃肠功能恢复后直接行全身静脉化疗(方案同A组)。观察患者1、3、5年局部复发率,远处转移率及生存率,分析A组患者临床病理特征与5年局部复发率及生存率的相关性。结果 A组1、3、5年局部复发率分别为0、1.68%(4/238)、3.79%(8/211),1、3、5年远处转移率为0.80%(2/249)、4.62%(11/238)、10.90%(23/211),1、3、5年生存率为100%、77.73%(185/238)、72.04%(152/211);B组1、3、5年局部复发率分别为0、9.52%(6/63)、16.36%(9/55),1、3、5年远处转移率为1.49%(1/67)、15.87%(10/63)、27.27%(15/55),1、3、5年生存率为100%(67/67)、58.73%(37/63)、52.73%(29/55)。两组1年局部复发率、远处转移率及生存率比较无统计学差异(P>0.05),A组3、5年局部复发率及远处转移率较低,3、5年生存率较高,两组比较差异有统计学意义(P<0.05)。肿瘤分化程度及Duke's分期是5年局部复发率、远处转移率及生存率的影响因素。结论直肠癌根治术后置泵灌注化疗加全身静脉化疗可明显提高患者的长期生存率,降低5年局部复发率和转移率。肿瘤分化程度以及Duke's分期也是影响患者疗效和生存的重要因素。

Objective To evaluate the effects and practicability of radical resection for low rectal carcinoma with infusion pump chemotherapy via internal iliac artery,and explore the correlation factors influencing the therapeutic effects.Methods Data of 316 patients with low rectal carcinoma,admitted from Oct.1997 to Mar.2008,were retrospectively analyzed and assigned into 2 groups according to the treatment： Patients received infusion pump chemotherapy via internal iliac artery to target area combined with intravenous systemic chemotherapy were assigned into group A（n=249）,and those receiving systemic chemotherapy alone following radical resection were assigned to group B（n=67）.The timing of pump chemotherapy to target area in group A was set at day 12 after recovery of digestive function,with regimen of 5-FU at 0.5g per dose plus hydroxycamptothecin at 10-15mg per dose,twice a week,four times as a treatment course for a total of 6 courses,and it was followed by intravenously systemic chemotherapy with a regimen of FOLFIRI or FOLFOX.In group B,at day 12 right after recovery of digestive function,the intravenous sytemic chemotherapy was started with the same regimen as in group A.The local recurrence rate,metastasis rate and survival rate after 1,3 and 5 years in the two groups were respectively observed and compared,and the correlation between the clinicopathological features and the 5 year local recurrence rates and survival rates was analyzed in patients of group A.Results In group A,the local recurrence rate at year 1,3 and 5 was 0,1.68%（4/238） and 3.79%（8/211）,respectively,the metastasis rate was 0.80%（2/249）,4.62%（11/238） and 10.90%（23/211）,respectively,and the survival rate was 100%,77.73%（185/238） and 72.04%（152/211）,respectively.In group B,the local recurrence rate at year 1,3 and 5 was 0,9.52%（6/63） and 16.36%（9/55）,respectively,the metastasis rate was 1.49%（1/67）,15.87%（10/63） and 27.27%（15/55）,respectively,and the survival rate was 100%（67/67）,58.73%（37/63） and 52.73%（29/55）,respectively.There was no significant difference between the two groups（P0.05） for 1-year local recurrence rate,metastasis rate and survival rate.The 3-and 5-year local recurrence rates and metastasis rates were lower and the survival rate was higher in group A than in group B（P0.05）.The degree of differentiation of the tumor and Duke＇s stage of cancer may be the factors influencing the 5-year local recurrence rate,metastasis rate and survival rate.Conclusions The chemotherapy via internal iliac artery with an implanted pump following radical resection for low rectal carcinoma may give a satisfactory effect on the cure rate for low rectal cancer by lowering the 5-year local recurrence rate and metastasis rate and raising the survival rate.Degree of differentiation of the tumor and Duke＇s stage may play an important role in therapeutic effectiveness-and survival of the patients.