中晚期直肠癌新辅助放化疗后的手术时机研究

Impact of interval between noeadjuvant chemoradiotherapy and surgery on short and long-term outcomes of patients with rectal cancer

目的探讨中晚期直肠癌新辅助放化疗后的最佳手术时机。方法根据新辅助放化疗结束至手术的时间间隔，将117例中晚期直肠癌患者分为短间隔组（≤7周）和长间隔组（〉7周），比较两组患者的术后病理、短期疗效、肿瘤复发转移和患者生存等的差异。结果短间隔组病理完全缓解（PCR）8例，长间隔组20例（P＝0.415）。短间隔组T降期23例，长间隔组40例（P＝0.039）。短间隔组N降期21例，长间隔组38例（P＝0.033）。短间隔组近期疗效为有效28例，稳定20例，进展5例；长间隔组有效47例，稳定14例，进展3例，两组差异无统计学意义（P＝0.068）。短间隔组和长间隔组患者的3年局部复发率分别为17.0%和4.7%，差异有统计学意义（P＝0.029）；3年无复发发生率分别为64.2%和79.7%，两组差异无统计学意义（P＝0.061）。新辅助放化疗后第10周接受手术的12例患者中，4例达到PCR，PCR率最高。结论中晚期直肠癌新辅助放化疗后间隔7周以上进行手术可提高PCR率，降低局部复发率。

ObjectiveTo explore the best surgical timing after neoadjuvant chemoradiation for advanced rectal cancer patients.MethodsAccording to the time interval between neoadjuvant chemoradiation and surgery, 117 patients with advanced rectal cancer were divided into short interval group （≤7 weeks, n=54） and long interval group （〉7 weeks, n=64）. The endpoints included postoperative pathology, short-term efficacy, tumor recurrence and patient survival between the two groups.ResultsThere were 8 cases PCR in short interval group and 20 cases in long interval group（P=0.415）. There were 23 cases of T downgrade in short interval group and 40 cases in the long interval group, which has significant difference （P=0.039）. There were 21 cases of N downgrade in short interval group and 38 cases in long interval group, which has significant different （P=0.033）. The short-term group was effective in 28 cases, stable in 20 cases, and progressed in 5 cases. In short term efficacy comparison, the cases of complete response, stable disease and progressive disease in short interval group was 28 cases, 20 and 5, long interval group was 47 cases, 14 cases and 3 cases, which has no significant difference（P=0.068）. The 3-year local recurrence rate of short interval group and long interval group was 17.0% and 4.7%, respectively, and the difference was statistically significant（P=0.029）. The incidence of recurrence in 3 years of short interval group and long interval group was 64.2% and 79.7%, respectively, and the difference was not significant （P=0.061）. The highest PCR rate was reached in the 10th and 11th week after neoadjuvant chemoradiotherapy. Of the 12 and 8 patients who underwent surgery, 3 （25.0%） and 2 （25.0%） achieved PCR, respectively.ConclusionPCR and local recurrence rate might be improved by time interval between neoadjuvant chemoradiation and surgery was more than 7 weeks.