术前同步放化疗后yp0-Ⅰ期直肠癌预后分析

Prognostic factors in patients with stage yp0？I rectal cancer after preoperative concurrent chemoradiotherapy

目的 探讨局部晚期直肠癌术前同步放化疗后yp0-Ⅰ期的预后及影响因素.方法2008—2013年纳入研究87例局部晚期直肠癌术前同步放化疗后yp0-Ⅰ期患者,均接受术前同步放化疗后4-8周进行TME.放疗给予全盆腔外照射45.0-504 Gy,同步给予单药卡培他滨或卡培他滨联合奥沙利铂化疗.采用Kaplan-Meier法计算LRFS、DMFS、DFS和OS并Logrank检验和单因素预后分析,Cox模型多因素预后分析.结果术前同步放化疗与手术间隔中位时间为51 d.TME术后共45%接受了术后辅助化疗.3年LRFS、DMFS、DFS和OS分别为98%、93%、93%和96%.多因素分析发现基于疗前临床分期和术后病理分期的降期深度评分与DMFS、DFS相关（P=0020、0005）.降期深度评分5分为界值,预测3年DFS的ROC的AUC值为0803.结论术前同步放化疗后yp0-Ⅰ期直肠癌的长期生存结果较好.降期深度评分可以预测预后.

Objective To determine the prognostic factors in patients with stage yp0-I rectal cancer following preoperative concurrent chemoradiotherapy. Methods Eighty-seven patients who received preoperative concurrent chemoradiotherapy and total mesorectal excision （ TME） for stage yp0-I rectal cancer from January 2008 to December 2013 were enrolled into the present study. TME was performed 4-8 weeks after the concurrent chemoradiotherapy （ CRT） . Whole pelvic radiotherapy was given at a dose of 450-504 Gy, along with concurrent chemotherapy using capecitabine or capecitabine combined with oxaliplatin. Local recurrence-free survival （LRFS）, distant metastasis-free survival （DMFS）, disease-free survival （DFS）, and overall survival （ OS） were calculated using the Kaplan-Meier method, and compared by the Logrank test. Univariate and multivariate prognostic analyses were performed using the Logrank test and the Cox model, respectively. Results The median interval between preoperative CRT and TME surgery was 51 days. Approximately 45% of the patients received adjuvant chemotherapy following TME. The 3-year LRFS, DMFS, DFS, and OS were 98%, 93%, 93%, and 96%, respectively. The multivariate prognostic analysis showed that the downstaging depth score （ DDS ） , which is based on the pre-treatment clinical stage and postoperative pathological stage, was correlated with DMFS and DFS （ P=0020 and 0005, respectively） . The area under the receiver operating characteristic curve of DDS for predicting 3-year DFS was 0803 at a cut-off value of 5 points. Conclusions Satisfactory long-term survival is achieved in patients with yp0-I stage rectal cancer after preoperative CRT, and DDS can be used as a prognostic factor for long-term survival.