305例局部晚期直肠癌术前化疗对比同步放化疗联合全直肠系膜切除的疗效

Comparison of preoperative chemotherapy with concurrent chemoradiotherapy combined with TME for 305 patients with locally advanced rectal cancer

目的分析局部晚期直肠癌术前化疗或放化疗联合全直肠系膜切除的疗效及预后。方法收集2006—2018年中国医学科学院肿瘤医院收治的局部晚期305例直肠癌患者的临床病理资料,其中246例患者接受术前放化疗(术前放化疗组),59例患者接受术前化疗(术前化疗组),生存分析采用Kaplan-Meier法和Log rank检验,多因素分析采用Cox回归模型,采用倾向评分匹配(PSM)分析两组患者预后。结果全组305例患者,肿瘤位于直肠上段20例,直肠中段96例,直肠下段189例。术前化疗组cT2~3期38例,cT4a期11例,cT4b期10例,术前放化疗组分别为184、0和62例,差异有统计学意义(P<0.05)。术前放化疗组与术前化疗组患者R0切除率分别为100%(246/246)和96.6%(57/59),病理完全缓解率分别为13.4%和3.3%,差异均有统计学意义(P<0.05)。PSM后,术前放化疗组与术前化疗组患者的3年生存率分别为86.6%和89.9%(P>0.05),无病生存率分别为74.6%和77.2%(P>0.05),无局部复发生存率分别为96.2%和90.8%(P>0.05),无远处转移生存率分别为75.6%和77.3%(P>0.05)。治疗前N阳性、是否N降期和直肠系膜筋膜阳性均与总生存有关(均P<0.05)。结论在术前放化疗组中,T4b期和下段直肠癌患者比例更高的情况下,术前放化疗与术前化疗远期疗效近似,术前放化疗可获得更高的R0切除率和病理完全缓解率。

Objective To retrospectively analyze the long-term efficacy and prognostic factors of preoperative chemotherapy(PCT)or chemoradiotherapy(PCRT)combined with total mesorectal excision in locally advanced rectal cancer.Methods Clinical pathology data of 305 patients with localized advanced rectal cancer admitted to the Cancer Hospital,Chinese Academy of Medical Sciences from 2006 to 2018 were collected,of whom 246 patients received PCRT(PCRT group),59 patients received PCT(PCT group).Kaplan-Meier and Log rank test were used for the survival analysis,Cox regression model was used for multivariate analysis,and the prognosis of two groups of patients were compared by the propensity score matching(PSM).Results In the whole group of 305 patients,20 cases of tumors located in the upper part of the rectum and at the junction of rectum and colon,96 cases in the middle of the rectum and 189 cases in the lower part of the rectum.PCRT group included 38 cases of cT2-3 phase,11 cases of cT4a stage,10 cases of cT4b stage,while the cases in PCT group were 184,0 and 62 cases,respectively,the difference is statistically significant(P<0.05).The R0 excision rates of PCRT group and PCT group were 100%(246/246)and 96.6%(57/59),respectively,and the total pathological remission rates were 13.4%and 3.3%,respectively(P<0.05).After PSM,the 3-year survival rates of PCRT group and the PCT group were 86.6%and 89.9%(P>0.05),respectively,and the progression-free survival rates were 74.6%and 77.2%(P>0.05),local recurring free survival rates were 100%and 92.3%(P>0.05),distant metastasis free survival rate were 75.6%and 77.3%(P>0.05).Pre-treatment N-positive,N-degeneration and MRF-positive were all associated with total survival(P<0.05).Conclusion In the PCRT group,with a higher proportion of patients with stage T4b and lower rectal cancer,the long-term efficacy of PCRT was similar to that of PCT,and higher R0 excision rate and pathological complete response rate could be obtained.