中低位直肠癌患者新辅助放化疗+根治术治疗的预后因素分析

Effect of neoadjuvant chemoradiotherapy plus radical surgery on prognosis of patients with rectal cancer and its influencing factors

目的探讨中低位直肠癌患者术前放化疗+根治术治疗的预后影响因素。方法收集2008年2月-2013年2月就诊于我院的直肠癌患者的临床资料。根据随访期间疾病进展情况,分为疾病进展组(发生复发、转移等)和无进展组(无复发转移等),绘制生存曲线,分析直肠癌患者预后的影响因素。结果根据患者预后情况分为无进展组133例,疾病进展组153例。Kaplan-Meier生存曲线显示患者发生不良预后的平均时间45.69个月(95%CI:43.59~47.79)。患者不良预后率为53.50%。Cox比例风险模型分析结果显示年龄(P=0.021)、肿瘤距肛门距离(P=0.004)、癌胚抗原(carcinoembryonic antigen,CEA)> 3.40 ng/ml(P=0.035)、是否临床完全缓解(clinical complete response,cCR)(P=0.005)是影响疾病进展的独立影响因素。结论晚期直肠癌新辅助放化疗后可一定程度改善患者生存情况,肿瘤距肛门距离、CEA水平、年龄、是否cCR与直肠癌患者预后有一定相关性。

Objective To investigate the effect of preoperative chemoradiotherapy plus radical surgery on prognosis of patients with middle and low rectal cancer. Methods Clinical data about 286 patients with rectal cancer admitted to our hospital from February 2008 to February 2013 were collected. According to the occurrence of adverse prognosis during the follow-up period, the patients were divided into progression group and progression-free group. The survival curve was drawn and the prognostic factors of rectal cancer patients were analyzed. Results According to the prognosis of patients, 133 patients were included in progression group and 153 patients in progression-free group. The Kaplan-Meier survival curve showed that the average time to poor prognosis was 45.69 months（95% CI： 43.59 to 47.79）, and the poor prognosis rate was 53.50%. Cox proportional hazard analysis showed that age（P=0.021）, distance to anus（P=0.004）, CEA〉3.40 ng/ml（P=0.035）, and whether cCR（P=0.005） were independent prognostic factors. Conclusion Neo-adjuvant chemoradiotherapy can improve the survival of patients with advanced rectal cancer to some extent. Distance to anus, CEA level, age, and whether cCR are correlated with the prognosis of patients with rectal cancer.