局部进展期中低位直肠癌新辅助治疗后病理消退影响因素分析

Influencing factors of good pathological tumor regression grades after neoadjuvant therapy in locally advanced rectal cancer

目的 :分析局部进展期中低位直肠癌患者新辅助治疗后病理消退相关影响因素,探讨规范化新辅助治疗对提高局部进展期直肠癌治疗效果的价值。方法:对2002年1月至2009年12月期间122例局部进展期中低位直肠癌患者接受新辅助治疗后行手术的临床资料及术后病理消退分级进行回顾性研究,logistic回归分析与直肠癌新辅助治疗后病理消退相关的影响因素。结果:122例患者中明显病理消退52例,其中完全病理消退11例,病理消退不明显70例。长程放疗方案病理明显消退率高于短中程放疗(60%vs30.56%,P=0.005),同步放化疗病理明显消退率高于单纯放疗(54.05%vs 25%,P=0.002),放疗总量>4 000 cGy病理明显消退率高于总量≤4 000 cGy(60.42%vs 31.08%,P=0.001),logistic回归分析显示同步放化疗及长程放疗是局部进展期直肠癌患者新辅助治疗后病理消退分级的两个独立影响因素(P<0.05)。自2006年1月至2009年12月4年间接受新辅助治疗的直肠癌患者(A组,66例)中同步放化疗、长程放疗、放疗总量达到4 000 cGy以上及术前放化疗后时间间隔达到6周的比率均高于自2002年1月至2005年12月4年间接受新辅助治疗的直肠癌患者(B组,56例)(71.43%vs 51.51%,57.14%vs 27.27%,48.21%vs 30.30%,50%vs 28.79%)。结论:局部进展期中低位直肠癌行长程放疗、同步放化疗临床疗效优于短中程放疗、单纯术前放疗,延长术前同步放化疗后时间间期有提高临床疗效的趋势,规范化术前同步放化疗可提高局部进展期直肠癌患者的临床疗效。

Objective： To analyze the influencing factors of good pathological tumor regression grades after neoadjuvant chemoradiotherapy （CRT） in locally advanced rectal cancer （LARC） and evaluate the value of stan- dardized concurrent preoperative CRT in improving the clinical efficacy in LARC. Methods： A total of 122 patients with LARC receiving neoadjuvant CRT between January 2002 and December 2009 were analyized retrospectively. The tumor regression grades （TRG） were detected by HE staining. Logistic regression analysis was used to evaluate the influencing factors associated with clinical efficacy after neoadjuvant CRT in LARC. Results： Fifty-two patients reached good TRG, including 11 patients with pathological complete response, 70 patients were poorly responsive to radiation. The good response rate after long-course radiation therapy （RT） was significantly higher than that of patients who underwent short/medium course RT （60% vs 30.56%, P=0.005）, the good response rate with concurrent preoperative CRT was significantly higher than that of patients with preop- erative RT alone （54.05% vs 25%, P=0.002）, the good response rate after RT dose〉4 000 cGy was significantly higher th~：.!hat of patients underwent RT dose ≤ 4 000 cGy（60.42% vs 31.08%,P=0.001）. Logistic regression analysis showed the concurrent preoperaticve CRT and long-course RT were independently ：associated with theclinical efficacy in LARC after neoadjuvant CRT. The rate of patients received concurrent preoperative CRT, long- course RT, RT dose〉4 000 cGy and the interval between neoadjuvant CRT and surgery ≥ 6 weeks between January 2006 and December 2009 was significantly higher than that of patients between January 2002 and December 2005 （71.43% vs 51.51%, 57.14% vs 27.27%, 48.21% vs 30.30%, 50.0% vs 28.79%）. Conclusion： Concurrent preoperative CRT and long-course RT provide higher good response rate, standardized preoperative concurrent CRT may improve the clinical efficacy in patients with LACR.