Ⅱ、Ⅲ期直肠癌新辅助放化疗与手术间隔时间对术后病理及临床疗效的影响

Influence of the interval between preoperative radiation therapy and surgery on postoperative pathology and clinical curative effect for rectal cancer

目的:探讨局部晚期直肠癌新辅助放化疗结束与手术的间隔时间对病理及临床疗效的影响。方法:回顾性分析2010年1月至2013年7月间接受新辅助放化疗随后行根治性手术的78例初治局部晚期直肠癌患者的临床资料。根据新辅助治疗结束至手术的间隔时间中位数分为两组,A组为新辅助放化疗结束后﹤7周手术治疗38例;B组为≥7周手术治疗40例。全部患者采用三维适形调强放疗,2Gy/1次,5次/1周,总50Gy,同步行氟尿嘧啶为基础的化疗,比较两组患者肿瘤病理退缩分级(TGR)、降期率、手术并发症发生率、局部复发率、远处转移率和生存率。结果:TRG1、TRG2、TRG3、TRG4(PCR)A组分别为9例、7例、10例、6例,B组分别为9例、9例、12例、8例(P=0.614);T分期降期率A组63.2%,B组52.5%(P=0.368),N分期降期率A组39.5%,B组55%(P=0.039);手术并发症发生率A组18.4%,B组20%(P=0.550);3年复发率A组7.9%,B组10%(P=0.745);远处转移率A组13.2%,B组10%(P=0.663);3年生存率A组70.8%,B组84%(P=0.453)。结论:新辅助放化疗结束≥7周行手术,可以获得较高的淋巴结降期率,不增加手术难度和并发症发生率。

Objective：To determine the influenee of neoadjuvant ehemoradiotherapy （CRT） and surgery interval on pathologieal and oneologieal outeomes. Methods：A retrospeetive review was performed of 78 patients with loeally advaneed reetal eaneer under-went neoadjuvant ehemoradiation followed by radieal reseetion. The patients were divided into two groups according to the neoadjuvant -surgery interval 〈 7weeks （group A,n = 38 ）, and ≥7weeks （group B, n = 40）. All patients were treated concurrently with 5 - Fluorouracil based chemotherapy and pelvic radiation （50Gy/ 5weeks）. Pathologic and clinical coutcomes, surgical complications were compared between the two groups. Results： There was no difference in the tumor rgession grades between the two groups （TRG1, TRG2, TRG3, TRC,4 were 9 ca- ses,7 cases,10 cases,6 cases in group A vs 9 cases,9 cases, 12 cases ,8 cases in group B respectively, P =0. 614）. Two groups were similar in terms of T - level downstaging rate （A：63.2% vs B：52.5% ,P =0. 368）. There was sig- nificant difference in the N downstaging rate （group A,39.5% vs group B ,55% ,P = 0. 039）. The surgical complications （ P = 0. 550）, local recmTence （ P = 0. 745 ）, distant metastasis （ P = 0. 663 ）, and overall sin-rival （ P = 0. 453 ） rates were not significantly different. Conclusion： A neoadjuvantsurgery interval ≥ 7weeks was associated with higher rates of nodal downstaging rates without increasing surgical scomplications, local recmTence and distant metas- tasis. Prolonged intervals could potentially improve survival rate.