直肠癌黏液湖比例对新辅助化疗疗效的影响探讨

Different curative effect of preoperative chemoradiotherapy of rectal cancer in subgroups with different proportion of mucous lake

目的比较黏液湖比例不同的直肠癌术前新辅助放化疗(CRT)的疗效。方法经病理确诊为直肠癌患者323例均在新辅助治疗前行直肠MRI检查(包括T_2WI及T_1WI序列)。按照T_2WI上高信号黏液湖占整体肿瘤的比例分为以下几组:无任何黏液湖(组0),黏液湖比例1%~25%(组1),黏液湖比例26%~50%(组2),黏液湖比例51%~75%(组3),黏液湖比例76%~100%(组4)。对照新辅助治疗前首诊MRI分期(mrTN)与术后病理分期(pTN)以及肿瘤退缩程度,尝试比较不同组间降期率及疗效反应程度间差异。结果黏液湖比例不同的五组之间T降期率有显著的统计学差异(P=0.002),其中组4的降期率高于组3(5/7,6/26),但无统计学差异。五组间N降期率没有显著的统计学差异(84.6%、79.5%、76.9%、84.6%、76.9%,P=0.081)。完全缓解率(CR)方面,组3明显低于其他组,但组4高于其他组。结论直肠癌不同比例黏液湖之间存在疗效差异,部分黏液腺癌仍然可以达到完全缓解。

Objective To compare curative effects after preoperative chemoradiotherapy（CRT） in subgroups with different proportion of mucous lake of rectal cancer.Methods 323 patients with rectal cancer underwent rectal MRI including T_1-and T_2-weighted imaging（T_2WI） before CRT.The patients were divided into conventional adenocarcinoma with no（GrouP〈0）,1 %-25 %（Group 1）,26%-50%（Group 2）,51%-75%（Group 3）,or 76%-100%（Group 4） mucous lake in the whole tumor area on T2 WI.The TN downstaging and degree of tumor regression after CRT were evaluated in the different subgroups.Results The five subgroups with different proportions of mucous lake had significantly different T downstaging rate（P =0.002） with Group 4（5/7）higher than that of Group 3（6/26）.There were no significant difference（P = 0.081） of N downstaging rate in the five subgroups（84.6%,79.5%,76.9%,66.7%,76.9%）.Conclusion The efficacy of neoadjuvant therapy varies with different proportions of mucous lakes of rectal cancer.