新辅助放化疗联合全直肠系膜切除术治疗中低位进展期直肠癌的临床研究

Clinical study of neoadjuvant chemoradiotherapy in combination with total mesorectal excision in treatment of advanced middle and lower rectal carcinoma

目的探讨新辅助放化疗联合全直肠系膜切除(TME)手术治疗中低位进展期直肠癌的疗效及安全性。方法回顾性分析2010年1月至2011年1月收治的56例中低位进展期直肠癌患者临床资料,28例接受新辅助放化疗联合TME手术治疗,设为观察组;28例仅接受TME手术,设为对照组。观察两组患者治疗前后TNM分期、肿瘤标志物水平及不良反应,比较两组切缘无癌细胞(R0)切除率、保肛率、局部复发率及转移率。结果观察组新辅助放化疗后TNM分期显著改善,与治疗前相比较差异有统计学意义(μ=1.960,P=0.000);癌胚抗原CEA及糖链抗原CA19-9、CA242、CA724等肿瘤标志物水平均显著降低,与治疗前相比较差异有统计学意义(t值分别为9.276、8.716、9.420、6.512,均P<0.01)。观察组R0切除率(89.28%vs 60.71%,χ2=6.095,P=0.014)及保肛率(75.00%vs 32.14%,χ2=10.338,P=0.001)均显著高于对照组。随访1年,观察组术后局部复发率(7.14%vs 28.57%,χ2=4.383,P=0.036)及远处转移率(21.43%vs 46.43%,χ2=3.903,P=0.048)显著低于对照组,差异有统计学意义。结论新辅助放化疗联合TME手术治疗中低位局部进展期直肠癌疗效确切,值得临床推广使用。

Objective To evaluate the effect and security of neoadjuvant chemoradiotherapy in combination with total mesorectal excision （TME） in treatment of advanced middle and lower rectal carcinoma. Methods Fifty-six patients of advanced middle and lower rectal carcinoma were retrospectively recruited and divided into observation group and control group from January 2010 to January 2011, with 28 cases in each group. Neoadjuvant chemoradiotherapy combined with TME were given to observation group and TME alone was performed in control group. TNM stage, tumor marker levels and adverse reactions were recorded before and after neoadjuvant chemoradiation. The R0 radical resection rate, sphincter preservation rate, local recurrence rate and metastasis rate were compared between the two groups. Results After neoadjuvant chemoradiation, the TNM stage in observation group improved significantly, the difference statistically significant compared with that before treatment （μ=1.960,P=0.000）. In the meantime, the levels of CEA, CA19-9, CA242 and CA724 in observation group significantly decreased, and the difference was statistically significant compared with that before treatment （t=9.276, 8.716, 9.420, 6.512, all P〈0.01）. The R0 radical resection rate and sphincter preservation rate of observation group were significantly higher than control group （89.28%vs 60.71%,75.00%vs 32.14%,χ2=6.095, 10.338, P=0.014, 0.001）. After a 1-year follow-up, local recurrence rate and metastasis rate of observation group were significantly lower than those of control group, with statistically significant differences （7.14%vs 28.57%, 21.43%vs 46.43%,χ2=4.383, 3.903, P=0.036, 0.048）. Conclusion Neoadjuvant chemoradiotherapy combined with TME can obtain improved curative effect in treatment of advanced middle and lower rectal carcinoma, and it is worthy of clinical application.