直肠癌新辅助放化疗后腔内超声下TN分期与术后病理的相关性分析

Correlation between ultrasonic TN staging and postoperative pathology in rectal cancer after neoadjuvant radiochemotherapy

目的评估超声内镜（ERUS）判断直肠癌新辅助放化疗后TN分期的准确性并探讨放化疗后TN分期变化与术后病理反应程度的相关性。方法选择本院2013年1月至2013年12月收治的40例直肠癌患者为研究对象,均给予三维适形或调强放疗（DT 50Gy/25次）,于放疗第1天开始口服替吉奥胶囊,根据体表面积确定剂量,连服2周,停药1周为1周期,连续用药2个周期,于放化疗结束后6~8周行手术。每例患者分别于术前行ERUS检查和术后病理确定分期,比较术前ERUS分期与术后病理分期结果,分析腔内超声检查对TN分期、T分期及N分期判断的准确率。结果腔内超声检查对T1、T2、T3和T4期的诊断准确率分别为77.8%、76.9%、83.3%和83.3%,T分期诊断准确率为80.0%。N0和N＋期的诊断准确率分别为84.4%和62.5%,N分期诊断准确率为80.0%。TN分期诊断准确率为72.5%。结论 ERUS在T分期及N分期上均具有较高的准确性,是直肠癌术前分期最常用的检查手段之一。

Objective To evaluate the accuracy of endorectal ultrasound （ERUS） in the TN staging of rectal cancer after neoadjuvant ehemoradiation in comparison with postoperative pathology. Methods Forty patients with rectal cancer were chosen in our hospital from January 2013 to December 2013. All patients received dimensional con_formal radiotherapy or intensity modulated radio- therapy （DTSOGy/25 fractions）. From the first day of radiotherapy, S-1 capsules were administered orally for two periods which inclu- ding two weeks administration and one week drug withdrawal. Operations were carried out in six to eight weeks after chemoradiation. Pa- tients were given ERUS before operation and postoperative pathology. Stages of patients before and after operation were compared. Re- suits The diagnosis accuracy rates of ERUS for Tl , T2, T3 and T4 stage were 77. 8%, 76. 9%, 83.3% and 83.3%, respectively. The total diagnosis accuracy rate of T stage was 80. 0%. The diagnosis accuracy rates of endosonography for No and N＋ stage were 88.4% and 62. 5%, respectively. The total diagnosis accuracy rate of N stage was 80. 0%. The total diagnosis accuracy rate of TN was 72. 5%. Conclusion ERUS has good accuracy in T stage and N stage diagnosis. It is one of the most common used detective methods in preop- erative diagnosis of rectal cancer.