E-PASS量表评估新辅助化疗对结直肠癌患者术后风险发生的影响

Estimation of Physiologic Ability and Surgical Stress for Neoadjuvant Chemotherapy on Postoperative Risk of Colorectal Cancer

目的以生理能力和手术应激评估(E-PASS)量表作为风险评估工具,探讨新辅助化疗是否会增加结直肠癌患者术后的风险。方法回顾性分析2009年1月至2009年12月期间在四川大学华西医院胃肠外科中心住院并由同一治疗组手术治疗的161例结直肠癌患者的临床资料,其中新辅助化疗组78例,非新辅助化疗组83例,运用E-PASS量表计算术前风险评分(PRS)、手术应激评分(SSS)和综合风险评分(CRS),比较2组各评分的差异。结果 2组患者基本情况比较差异无统计学意义(P>0.05)。新辅助化疗组术后并发症总发生率为10.26%(8/78),非新辅助化疗组术后并发症总发生率为7.23%(6/83),2组并发症总发生率比较差异无统计学意义(P>0.05)。新辅助化疗组的平均PRS、SSS及CRS分别为78.42、80.77及80.74分,非新辅助化疗组分别为83.42、81.22及81.24分,2组PRS、SSS及CRS比较差异均无统计学意义(P值分别为0.497、0.951及0.976)。E-PASS量表在新辅助化疗组和非新辅助化疗组分别准确评估了70例和78例的手术风险,2组间比较差异同样无统计学意义(P=0.325)。结论新辅助化疗不会增加结直肠癌患者的术后风险,E-PASS量表可以较为准确地评价新辅助化疗患者的手术风险。

Objective To explore the effectiveness of neoadjuvant chemotherapy on postoperative risk of colorectal cancer by use of estimation of physiologic ability and surgical stress（E-PASS）.Methods A total of 161 patients with colorectal cancer according to the inclusion criteria from January 2009 to December 2009 in West China Hospital of Sichuan University were analyzed retrospectively,who were assigned to neoadjuvant chemotherapy group（NC group,78 patients）and non-NC group（83 patients）.The postoperative risk of each group was assessed by the E-PASS scale including preoperative risk score（PRS）,surgical stress score（SSS）,and comprehensive risk score（CRS）.Results The baseline of two groups had no significant difference（P0.05）.The postoperative complication incidence of two groups had no significant difference either（P0.05）,which was 10.26%（8/78）in the NC group,and 7.23%（6/83）in the nonNC group.The PRS was 78.42 in the NC group and 83.42 in the non-NC group（P=0.497）.The SSS was 80.77 in the NC group and 81.22 in the non-NC group（P=0.951）.The CRS was 80.74 in the NC group and 81.24 in the nonNC group（P=0.976）.The accuracy of the postoperative risk assessment was 70 cases and 78 cases in the NC group and non-NC group,respectively.There was no significant difference of accuracy between two groups（P=0.325）.Conclusions Neoadjuvant chemotherapy does not increase the risk of patients with colorectal cancer after operation,and the results suggest that E-PASS scale can provide a more accurate assessment of neoadjuvant chemotherapy in patients with surgical risk.