术后辅助化疗对ypN_0局部进展期直肠癌疗效观察

Effect of adjuvant chemotherapy on patients with locally advanced rectal cancer showing ypN0 after radical surgery following neoadjuvant chemoradiotherapy

目的评价术后辅助化疗对ypN_0局部进展期直肠癌的治疗效果。方法选取2004年9月至2010年9月周口市中心医院直肠肛门外科收治的局部进展期直肠癌患者,进行同步放化疗,治疗结束后6~8周行根治性手术,根据术后病理检查结果将ypN_0患者纳入本项研究,随机分成两组,观察组术后2~4周给予辅助化疗,对照组不再给予辅助放疗或化疗。结果观察组和对照组的5年局部复发率(5.2%vs 10.8%)、5年无瘤生存率(86.5%vs 82.4%)、5年总体生存率(89.6%vs 85.3%)无明显差异(P>0.05);ypT_(3 ~ 4)组接受术后化疗者5年局部复发率2.8%明显低于未接受术后化疗者的22.0%(P<0.05),而在ypCR、ypT_(is^2)组未发现这种差异(P>0.05);ypCR、ypT_(is^2)、ypT_(3 ~ 4)三组患者中是否接受术后化疗在5年无瘤生存率、5年总体生存率上无明显差异(P>0.05)。结论术后化疗能降低ypT_(3 ~ 4)N_0患者5年局部复发率,对ypCR、ypT_(is^2)N_0患者作用不大。

Objective To evaluate the effect of adjuvant chemotherapy on patients with locally advanced rectal cancer showing ypNo after radical surgery following neoadjuvant chemoradiotherapy （NCRT）. Method Patients with locally advanced rectal cancer showing ypN0 after radical surgery following NCRT from September 2004 to September 2010 were randomized classfied into observational group and control group. Adjuvant chemotherapy was recommended to observational group and none to control group. Results The 5-year local recurrence rate （5.2% vs 10. 8% ）, 5-year disease-free survival rate （86. 5% vs 82.4% ） and 5-year overall survival rate （89. 6% vs 85. 3% ） between the two groups had no significant difference （P 〉0. 05）. In the ypT3-4 group, there was a statistically significant difference in the 5-year local recurrence rate （2. 8% vs 22.0% ） between patients undergoing adjuvant chemotherapy or not （P 〈0. 05）. In the ypCR and ypTis-2 group, there was no difference （P 〉 0. 05 ）. In the ypCR, ypTis-2 and ypT3 -4 group, there was not a statistically significant difference in the 5-year disease-free survival and 5-year overall survival between patients undergoing adjuvant chemotherapy or not （P 〉 0. 05）. Conclusion Adjuvant chemotherapy improved the 5-year local recurrence rate in the ypT3.4 No group.