47例局部晚期为主直肠癌放化疗临床分析

Chemoradiotherapy for locally advanced rectal cancer：a clinical analysis of 47 patients

目的：探讨局部晚期为主直肠癌单纯放化疗疗效与预后因素分析。方法回顾分析2003—2010年收治的47例放化疗为主的局部晚期直肠癌患者资料，其中3例单纯放疗。 Kaplan-Meier法计算OS、PFS、DMFS并Logrank检验和单因素预后分析，Cox模型多因素预后分析。结果全组3、5年OS率分别为53％和33％，PFS率分别为37％和31％。局部进展15例（32％），PFS期1～60个月（中位数14个月）；远处转移23例（49％），DMFS期2～60个月（中位数17个月）。中剂量和高剂量放疗的3、5年局部进展率分别为54％和11％、57％和11％（ P＝0.004）。放化疗后pCR 9例（19％），其3、5年OS和PFS均8例。单因素分析显示肿瘤距肛门距离（ P＝0.026）和是否cCR （ P＝0.000）均是影响预后因素，但多因素分析仅 cCR是影响生存的因素（HR＝12.24，95％ CI＝1．64～91.29，P＝0.015）。结论因各种原因放弃手术治疗或未能行手术切除的局部晚期直肠癌，放化疗或单纯放疗是一种安全有效方法。高剂量放疗可提高直肠癌LC率，放化疗的获得CR预示良好的预后。

Objective To evaluate the efficacy of chemoradiotherapy alone and prognostic factors for locally advanced rectal cancer. Methods The clinical data of 47 patients with locally advanced rectal cancer who were admitted to our hospital and mostly treated with chemoradiotherapy alone from 2003 to 2010 were retrospectively analyzed. Three of the patients received radiotherapy alone. The Kaplan.Meier method was used to estimate overall survival （OS）, progression.free survival （PFS）, and distant metastasis.free survival （ DMFS ） rates, and the log.rank test was used for survival difference analysis and univariate prognostic analysis. The Cox regression model was used for multivariate prognostic analysis. Results In all patients, the 3.and 5.year OS rates were 53.2% and 33.2%, respectively, while the 3.and 5.year PFS rates were 37% and 31%, respectively. During the follow.up, 15 patients （32%） had local progression with PFS of 1.60 months （median PFS, 14 months）;23 patients （49%） had distant metastasis with DMFS of 2.60 months （ median DMFS, 17 months） . Patients treated with high.dose radiotherapy had significantly lower 3.and 5.year local progression rates than patients treated with medium.dose radiotherapy （ 11% vs. 54%;11%vs. 57%;P=0.004）. After chemoradiotherapy, 9 patients （19%） had clinical complete response （cCR）, and the 3.and 5.year OS and PFS rates in those patients were all 8/9. The univariate analysis indicated that tumor distance from the anus and cCR were influencing factors for prognosis （ P= 0.026;P= 0.000 ） . However, the multivariate analysis showed that cCR was the only influencing factor for survival （ HR=12.24;95% CI, 1.64 .91.29;P= 0.015 ） . Conclusions Chemoradiotherpay or radiotherapy alone is effective and safe in the treatment of patients with locally advanced rectal cancer who have to give up surgery or have unresectable tumors. High.dose radiotherapy may improve local control rate. Complete response to chemoradiotherapy predicts satisfactory treatment outcomes.