辅助化疗对ypⅠ期直肠癌患者术后生存的影响

Influence of Adjuvant Chemotherapy on Survival in Patients with Rectal Cancer Stage Ⅰ After Neoadjuvant Therapy

[目的]比较Ⅰ期直肠癌与新辅助治疗后降期为yp T1~2N0M0的c T3~4或N＋的直肠癌患者5年总生存率的差异。[方法]回顾分析105例直肠癌根治术后病理分期为T1~2N0M0的直肠癌患者的临床病理资料及随访资料。按患者是否行新辅助治疗和辅助化疗分为3组。单纯手术组（A组）：未经术前新辅助治疗,p T1~2N0M0的早期直肠癌患者（29例）。新辅助降期化疗组（B1组）：初始诊断为c T3~4或N＋,术前行新辅助治疗后降期为yp T1~2N0M0,且术后行辅助化疗的直肠癌患者（54例）。新辅助降期非化疗组（B2组）：初始诊断为c T3~4或N＋,术前行新辅助治疗后降期为yp T1~2N0M0,且术后未行辅助化疗的直肠癌患者（22例）。对3组生存情况进行分析。[结果]新辅助治疗后降期为T1~2N0M0的直肠癌患者（B1＋B2组）术后5年生存率为94.0%。单纯手术组（A组）患者术后5年生存率为91.0%,新辅助降期化疗组（B1组）为88.9%,新辅助降期非化疗组（B2组）为90.9%。单因素分析提示3组预后差异无统计学意义（P〉0.05）。[结论 ]新辅助治疗后降期为T1~2N0M0的直肠癌患者无论是否行术后化疗都可获得与Ⅰ期直肠癌患者相同的预后。新辅助治疗后降期为T1~2N0M0直肠癌患者术后化疗并未能提高患者5年总生存率。

[Purpose ] To compare the 5-year survival between rectal cancer patients with initial stage [ and stage cT3＋4 or N＋ patients downstaging to ypT1-2N0M0 after neoadjuvant therapy . [ Methods ] One hundred and five rectal cancer patients with pathological stage T1-2N0M0 after rad- ical resection were retrospectively analyzed. They were divided into three groups according to with or without neoadjuvant therapy and adjuvant chemotherapy. Group A（n=29）： patients with surgery alone ,without neoadjuvant therapy, pTl-ENoMo. Group B 1 （n=54）：initially diagnosed as stage cT3-4 or N＋, downstaging to ypT1-2NoM0 after neoadjuvant therapy, and receiving postoperative adjuvant chemotherapy. Group B2 （n=22）： initially diagnosed as stage cT3-4 or N＋ ,downstaging to ypT1- 2N0M0 after neoadjuvant therapy,without postoperative adjuvant chemotherapy. Survivals in 3 groups were analyzed. [Results] The 5-year overall survival rate in patients downstaging to ypT1- 2N0M0 after neoadjuvant therapy （group Bl＋group B2）was 94.0%. And the 5-year overall survival rate was 91.0% ,88.9% and 90.9% in group A,group B1 and group B2 respectively. Univariate analysis showed no significant difference of prognosis among the 3 groups. [ Conclusion ] No matter with or without postoperative adjuvant chemotherapy ,rectal cancer patients downstaging to ypT1-2N0M0 after neoadjuvant therapy might have the similar prognosis to initial stage I patients . Pa- lents with neoadjuvant therapy will not benefit from adjuvant chemotherapy. Subject words： rectal neoplasms ; neoadjuvant therapy; downstaging ; prognosis ; surgery ; adjuvant chemotherapy