局部进展期中低位直肠癌新辅助放化疗临床疗效及预后影响因素分析

Clinical efficacy and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced low and middle rectal cancer

目的 探讨新辅助放化疗对局部进展期中低位直肠癌患者的临床疗效,研究相关临床因素对远期生存的影响.方法 收集我院2010-2014年收治的101例局部进展期中低位直肠癌患者的临床资料,全部患者完成术前调强放疗DT45~50. 4 Gy,同步给予奥沙利铂+卡培他滨/氟尿嘧啶或单药卡培他滨化疗,于新辅助治疗后4-13周行全直肠系膜切除术( TME).评估近期疗效及远期预后,Kaplan-Meier法计算总生存(OS)、无瘤生存(DFS)率,Cox回归模型进行预后因素分析.结果 全组患者总体保肛率53. 5%,术后T、N分期及TNM总分期下降率分别为73. 26%、67. 32%、72. 3%,病理完全缓解率16. 8%;中位随访41个月,3年OS、DFS、局部复发、远处转移率分别为82. 2%、80. 7%、7. 2%、12. 1%.单因素分析显示ypT、ypN分期是影响患者3年OS、DFS、远处转移的相关因素( P均<0. 05);多因素分析显示ypT分期是影响患者3年OS因素,ypT、ypN分期是影响患者3年DFS因素( P均<0. 05).结论 新辅助放化疗联合TME治疗局部进展期中低位直肠癌,使部分患者达到术前降期,提高保肛率,且远期预后表现良好,ypT、ypN分期与患者预后相关.

Objective To investigate the clinical efficacy of neoadjuvant chemoradiotherapy in the treatment of locally advanced low and middle rectal cancer,and evaluate the effect of related clinical factors upon the long-term survival. Methods Clinical data of 101 patients with locally advanced low and middle rectal cancer admitted to our hospital from January 1,2010 to December 31,2014 were collected. All patients completed the preoperative intensity-modulated radiation therapy DT45-50. 4 Gy,synchronized with oxaliplatin+capecitabine/5-fluorouracil or single drug capecitabine chemotherapy,and total mesorectal excision) was performed 4-13 weeks after the end of the neoadjuvant therapy. The short-term efficacy and long-term prognosis of these patients were evaluated. Kaplan-Meier method was used for survival analysis,and Cox’s regression model for multivariate analysis. Results The total sphincter preservation rate was 53. 5%.The decrease rates of T,N staging and TNM total staging were 73. 26%,67. 32% and 72. 3%,respectively. The pathological complete response ( pCR) rate was 16. 8%.The median follow-up time was 41 months. The 3-year overall survival (OS), desease-free survival (DFS),local recurrence and distant metastases rates were 82. 2%,80. 7%,7. 2% and 12. 1%,respectively. The single factor analysis demonstrated that ypT and ypN stages were the risk factors affecting the 3-year OS,DFS anddistant metastases ( all P<0. 05).Multivariate analysis revealed that ypT stage was an independent factor affecting the 3-year OS,and ypT and ypN stages were the independent factors of the 3-year DFS ( all P< 0. 05 ). ConclusionsNeoadjuvant chemoradiotherapy combined with TME in the treatment of locally advanced middle and low rectal cancer can partially decrease the tumor staging,enhance the sphincter preservation rate and improve long-term clinical prognosis. Both ypT and ypN stages are correlated with the clinical prognosis of patients.