局部进展期直肠癌新辅助放化疗后病理完全反应相关临床因素的研究

Clinical factors associated with complete pathological response in locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy

目的探讨局部进展期直肠癌新辅助放化疗后病理完全反应(pathologic complete response,pCR)相关的临床因素。方法回顾性分析新疆医科大学附属肿瘤医院2010年1月1日-2017年12月31日收治的接受新辅助放化疗联合全直肠系膜切除术(total mesorectal excision,TME)治疗的289例直肠癌患者资料,分为pCR组(n=53,18.3%)和非pCR组(n=236,81.7%)。采用单因素和二元Logistic回归分析法、ROC曲线评估与pCR反应相关的临床因素。结果治疗前癌胚抗原(carcinoembryonic antigen,CEA)、肿瘤最大径是影响pCR反应的独立因素,治疗前糖链抗原72-4(carbohydrate antigen 72-4,CA72-4)(P=0.004)、分化程度(P=0.012)对pCR反应有影响;ROC曲线结果显示治疗前平均表观扩散系数(apparent diffusion coefficient,ADC)值、ADC值增长率零阶矩曲线下面积(AUC)分别为0.648、0.746。结论治疗前CEA≤5 ng/mL、肿瘤最大径较短(≤3 cm)的患者获得pCR的机会更大,治疗前平均ADC值和增长比率在预测pCR中具有一定价值。

Objective To investigate the clinical factors associated with pathological complete response(pCR) in locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy. Methods A retrospective analysis was made of 289 cases of rectal cancer treated with neoadjuvant radiotherapy and chemotherapy combined with total mesorectal excision from January 1, 2010 to December 31, 2017. The patients were divided into pCR group(n=53, 18.3%) and non-pCR group(n=236, 81.7%). Univariate and binary logistic regression analysis and ROC curve were used to evaluate the clinical factors related to pCR reaction. Results Before treatment, CEA(carcinoembryonic antigen) and maximum diameter of tumors were independent factors affecting pCR. Before treatment, CA72-4(P=0.004) and differentiation degree(P=0.012) had effects on pCR. The results of ROC curve showed that the ADC(apparent diffusion coefficient) and area under curve(AUC) of zero-order moment of ADC average growth rate before treatment were 0.648 and 0.746 respectively. Conclusion Before treatment, patients with CEA ≤5 ng/mL and shorter tumor maximum diameter(≤3 cm) had a greater chance of obtaining pCR. Average ADC value and growth rate before treatment are valuable in predicting pCR.