直肠癌新辅助治疗后病理完全缓解和近似完全缓解患者的临床病理特征及预后分析

Clinicopathological characteristics and prognostic analysis of patients with pathological complete response and near complete response after neoadjuvant treatment of rectal cancer

目的探讨新辅助治疗后病理完全缓解和近似完全缓解的直肠癌患者的临床病理特征及预后特点。方法回顾性收集2004年1月至2016年12月在中国医学科学院肿瘤医院接受新辅助同步放化疗+根治性直肠癌手术患者的临床资料,分析其中病理完全缓解和近似完全缓解患者的临床病理特征及预后影响因素。结果共142例患者纳入本研究,其中男93例、女49例,年龄24~81岁,中位无病生存期53.9个月,中位总生存期55.0个月。单因素分析结果显示,术后瘢痕/病灶最大直径、淋巴结转移状态及肿瘤下缘距肛缘距离与患者无病生存期有关联;术后瘢痕/病灶最大直径及淋巴结转移状态和患者总生存期有关联。多因素Cox比例风险回归模型分析显示,术后瘢痕/病灶最大直径>3 cm(HR=4.406,95%CI:1.619~12.006)、淋巴结转移状态阳性(HR=4.102,95%CI:1.461~11.513)以及肿瘤下缘距肛缘距离≤4 cm(HR=18.171,95%CI:2.357~140.073)患者的无病生存期短;术后瘢痕/病灶最大直径>3 cm(HR=8.573,95%CI:1.630~45.099)和淋巴结转移状态阳性(HR=4.721,95%CI:1.068~20.860)患者总生存期短。结论直肠癌新辅助治疗后病理完全缓解及近似完全缓解患者总体预后较好;肿瘤下缘距肛缘距离、淋巴结转移状态及瘢痕/病灶最大直径是影响患者预后的相关因素。

Objective To investigate the clinicopathological characteristics and prognosis of rectal cancer patients with pathological complete response and near complete response after neoadjuvant therapy.Methods The clinicopathological data of patients who underwent neoadjuvant chemoradiotherapy plus radical surgery of rectal cancer in the Cancer Hospital of Chinese Academy of Medical Sciences from January 2004 to December 2016 were retrospectively collected.The clinicopathological characteristics and prognostic factor of patients with pathological complete response and near complete response were analyzed.Results The clinical data of 142 patients were collected.There were 93 males and 49 females,aged from 24 to 81 years.The median disease-free survival was 53.9 months and the median overall survival was 55.0 months.Univariate analysis showed that the maximum diameter of scar or lesion,the status of lymph node metastasis and the distance between the lower edge of tumor and anal edge were associated with disease-free survival time;the maximum diameter of scar or lesion and the status of lymph node metastasis were associated with overall survival time.Multivariate Cox proportional hazards regression analysis showed that patients with scar or lesion diameter>3 cm(HR=4.406,95%CI:1.619-12.006),positive lymph node metastasis status(HR=4.102,95%CI:1.461-11.513)and tumor lower margin to anal margin distance≤4 cm(HR=18.171,95%CI:2.357-140.073)had shorter disease-free survival time.The patients with scar or lesion diameter>3 cm(HR=8.573,95%CI:1.630-45.099)and lymph node metastasis status(HR=4.721,95%CI:1.068-20.860)had shorter overall survival time.Conclusions The overall prognosis of patients with pathological complete response or near complete response after neoadjuvant therapy for rectal cancer is better.The distance between the lower margin of the tumor and the anal edge,the status of lymph node metastasis and the maximum diameter of scars or lesion were the related factors affecting the prognosis of patients with rectal cancer.