中低位进展期直肠癌患者全直肠系膜切除术前应用同步新辅助放化疗效果分析

Application of synchronous neoadjuvant radiochemotherapy before total mesorectal excision operation in patients with advanced mid/low rectal cancer

目的分析中低位进展期直肠癌患者全直肠系膜切除术前同步新辅助放化疗应用疗效。方法选取45例中低位进展期直肠癌患者为研究对象,将其随机分为联合组(23例)与对照组(22例),对照组患者行单纯全直肠系膜切除术,联合组患者在行全直肠系膜切除术前同步新辅助放化疗,比较联合组新辅助放化疗前后肿瘤分期(TNM)情况,两组患者治疗前后肿瘤标志物水平变化情况及术后3个月保肛率、复发率、转移率、术后并发症发生情况。结果新辅助治疗后联合组TNM分期较治疗前降低,差异具有统计学意义(P﹤0.05);治疗前两组患者癌胚抗原(CEA)、糖链抗原19-9(CA19-9)、糖链抗原242(CA242)水平差异无统计学意义(P﹥0.05),治疗后均降低(P﹤0.05),且联合组低于对照组(P﹤0.05);两组患者术后3个月转移率及并发症发生率差异无统计学意义(P﹥0.05),联合组保肛率高于对照组,复发率低于对照组(P﹤0.05)。结论采用全直肠系膜切除术前同步新辅助放化疗,可以有效提高中低位进展期直肠癌患者保肛率,降低复发率,改善肿瘤TNM分期,降低CEA、CA19-9、CA242水平,具有良好的应用前景。

Objective To investigate the effect of synchronous neoadjuvant radiochemotherapy applied before total mesorectal excision operation in patients with advanced mid/low rectal cancer. Method 45 cases of patients with advanced mid/low rectal cancer were enrolled in the study, and were randomized as combined therapy group（n=23） and control group（n=22）, which were administered with preoperative synchronous neoadjuvant radiochemotherapy ＋ total mesorectal excision, and single total mesorectal excision, respectively. The tumor staging（TNM） in the combined therapy group before and after synchronous neoadjuvant radiochemotherapy and the changes of tumor markers in the two groups before and after treatment, as well as the anus preservation rates, recurrence rates and metastasis rates after 3 months of operation and the incidences of postoperative complications were compared. Result The TNM staging in the combined therapy after synchronous neoadjuvant radiochemotherapy was significantly decreased compared with that before treatment, with significant difference observed（P〈0.05）; Before treatment, the levels of cancer embryo antigen（CEA）, carbohydrate antigen 19-9（CA19-9） and carbohydrate antigen 242（CA242） were similar in the two groups（P〉0.05）, but were consistently decreased after treatment（P〈0.05）, with lower levels observed in the combined therapy group（P〈0.05）;There were no significant differences in the metastasis rates and incidences of complications between the two groups in 3months after operation（P〉0.05）, and the anus preservation rate in the combined therapy group was significantly higher,while the incidence of complications was significantly lower in the control group（P〈0.05）. Conclusion The application of synchronous neoadjuvant radiochemotherapy before total mesorectal excision operation can effectively improve the anus preservation rate for patients with advanced mid/low rectal cancer, with lower recurrence rate, better TNM staging,and decreased CEA, CA19-9 and CA242 levels, which is a promising procedure.