应用加速康复外科对结直肠癌术后早期行XELOX方案辅助化疗的2年预后分析

Two-year Prognostic Analysis of XELOX Adjuvant Chemotherapy in Early Postoperative Colorectal Cancer with Accelerated Rehabilitation Surgery

目的研究以加速康复外科理念为指导,对结直肠癌术后患者实施早期XELOX方案(奥沙利铂联合卡培他滨片)辅助化疗的效果。方法于2016年1月—2017年12月解放军第九〇四医院收入的结直肠癌根治手术患者中方便抽选60例作为研究样本,60例患者均应用加速康复外科程序进行围术期处理并均接受XELOX方案辅助化疗,采用随机双盲法将其中30例纳入常规组,剩余30例纳入早期组,两组分别于术后4周和术后2周开始辅助化疗,统计并比较两组患者术后2年内的不良反应发生率、复发率、远处转移率以及生存率。结果术后1年,早期组恶心呕吐、腹泻、手足综合征、周围神经毒性症状不良反应发生率(53.33%、16.67%、13.33%、20.00%)均高于常规组(36.67%、6.67%、3.33%、10.00%)(χ^2=5.607、4.851、6.548、3.922,P<0.05);术后2年,早期组恶心呕吐、腹泻、手足综合征、周围神经毒性症状不良反应发生率(50.00%、20.00%、16.67%、23.33%)与常规组(46.67%、13.33%、13.33%、16.67%)比较,差异无统计学意义(χ^2=0.222、1.602、0.437、1.386,P>0.05);早期组2年内复发率(0.00%)、远处转移率(3.33%)、生存率(96.67%),与常规组(3.33%、6.67%、93.33%)比较,差异无统计学意义(χ^2=3.386、1.174、1.174.P>0.05)。结论以加速康复外科理念为指导,对结直肠癌术后患者实施早期XELOX方案辅助化疗并不会显著提高结直肠癌患者术后2年的生存率,也不会显著降低患者术后2年的复发率和远处转移率,反而会增加患者术后1年的不良反应发生率,不过患者术后2年的不良反应发生率与常规XELOX方案辅助化疗患者不相上下,考虑早期XELOX方案辅助化疗可能会对结直肠癌术后患者的远期预后有一定影响,但具有还有待今后进一步研究。

Objective To study the effect of early XELOX(oxaliplatin combined with capecitabine)adjuvant chemotherapy on patients with colorectal cancer after the operation of accelerated rehabilitation surgery.Methods From January 2016 to December 2017,60 patients with colorectal cancer radical surgery who were included in the PLA's 904th Hospital were convenient selected as study samples.All 60 patients were treated with accelerated rehabilitation surgery for perioperative treatment and after receiving XELOX adjuvant chemotherapy,30 patients were included in the conventional group by random double-blind method,and the remaining 30 patients were included in the early group.The two groups started adjuvant chemotherapy at 4 weeks and 2 weeks after surgery,respectively.The incidence of adverse reactions,recurrence rates,distant metastasis rates,and survival rates within the next 2 years.Results One year after operation,the incidence of adverse reactions(53.33%,16.67%,13.33%,20.00%)of nausea and vomiting,diarrhea,hand-foot syndrome,and peripheral neurotoxicity in the early group were higher than those in the conventional group(36.67%,6.67%,3.33%,10.00%)(χ^2=5.607,4.851,6.548,3.922,P<0.05);2 years after operation,the incidence of adverse reactions to nausea and vomiting,diarrhea,hand and foot syndrome,and peripheral neurotoxicity in the early group(50.00%,20.00%,16.67%,23.33%)compared with the conventional group(46.67%,13.33%,13.33%,16.67%),the differences were not statistically significant(χ^2=0.222,1.602,0.437,1.386,P>0.05);the relapse rate(0.00%),distant metastasis rate(3.33%),and survival rate(96.67%)in the early group within 2 years were not statistically significantly different from those in the conventional group(3.33%,6.67%,93.33%)(χ^2=3.386,1.174,1.174,P>0.05).Conclusion Guided by the idea of accelerated rehabilitation surgery,the early XELOX adjuvant chemotherapy for patients with colorectal cancer after surgery will not significantly improve the two-year survival rate of patients with colorectal cancer after surgery,nor will it significantly reduce the patients'two-year after surgery.The recurrence rate and distant metastasis rate,on the contrary,will increase theincidence of adverse reactions at 1 year after surgery,but the incidence of adverse reactions at 2 years after surgery is similar to that of patients receiving conventional XELOX chemotherapy.Considering early XELOX chemotherapy may have some impact on the long-term prognosis of patients with colorectal cancer after surgery,but its future needs to be further studied.