直肠癌新辅助放化疗后病理完全缓解的临床因素研究

Clinical factors of pathological complete response after neoadjuvant chemoradiotherapy in rectal cancer

目的探讨应用临床因素预测直肠癌新辅助放化疗后病理完全缓解(pCR)的可行性。方法回顾性分析2011年1月至2018年12月在中国人民解放军总医院行新辅助放化疗的162例直肠癌患者的临床资料,根据术后病理结果将患者分为pCR组和非pCR组,寻找对直肠癌新辅助放化疗后pCR具有预测意义的临床因素。结果经新辅助放化疗后达到pCR者共28例(17.3%,28/162)。单因素分析显示,分化程度高的直肠癌(P=0.024)、肿瘤占据肠腔比例≤1/2(P=0.006)、较早的临床T分期(P=0.013)、较早的临床N分期(P=0.009)、新辅助放化疗结束至手术的时间间隔>49 d(P=0.006)、肿瘤最大直径≤5 cm(P=0.019)的患者更容易获得pCR,差异均有统计学意义。多因素分析显示,肿瘤占据肠腔比例≤1/2(P=0.01)、肿瘤最大直径≤5 cm(P=0.035)、新辅助放化疗结束至手术的时间间隔>49 d(P=0.009)是预测新辅助治疗后pCR的独立因素。结论肿瘤占肠腔比例、肿瘤最大直径、新辅助放化疗结束至手术的时间间隔能预测直肠癌新辅助放化疗后pCR。

Objective To explore the feasibility of clinical factors to predict the pathological complete response after neoadjuvant chemoradiotherapy in rectal cancer.Methods A retrospective analysis was performed on clinical factors of 162 patients with rectal cancer,who underwent neoadjuvant chemoradiotherapy in the General Hospital of People′s Liberation Army from January 2011 to December 2018.According to the postoperative pathological results,the patients were divided into pathological complete response(pCR)group and non-pathological complete response group(non-pCR group)to check the predictive clinical factors for pCR.Results Twenty-eight cases achieved pCR after neoadjuvant chemoradiation(17.3%,28/162).Univariate analysis showed that patients with higher differentiation(P=0.024),tumor occupation of the bowel lumen≤1/2(P=0.006),earlier clinical T stage(P=0.013),earlier clinical N stage(P=0.009),the time interval between neoadjuvant chemoradiotherapy and surgery>49 days(P=0.006),and maximum tumor diameter≤5 cm(P=0.019)were more likely to obtain pCR,and the differences werestatistically significant.Multivariate analysis showed that tumor occupation of the bowel lumen≤1/2(P=0.01),maximum tumor diameter≤5 cm(P=0.035),and the interval>49 days(P=0.009)were independent factors in predicting pCR after neoadjuvant therapy.Conclusion Tumor occupation of the bowel lumen,maximum tumor diameter,and the time interval between neoadjuvant chemoradiotherapy and surgery can predict the pCR in rectal cancer.