XELOX新辅助化疗对局部进展期低位直肠癌患者根治术R0切除率及恶性肿瘤标志物水平的影响

Effects of XELOX Neoadjuvant Chemotherapy on R0 Resection Rate and Malignant Tumor Marker Levels in Patients with Locally Progressive Low Rectal Cancer Undergoing Radical Resection

目的:探究XELOX新辅助化疗对局部进展期低位直肠癌患者根治术R0切除率及恶性肿瘤标志物水平的影响。方法:回顾性分析2019.08-2022.08于我院接受根治术的52例局部进展期低位直肠癌患者临床资料,纳入对照组;回顾性分析同期于我院接受XELOX新辅助化疗+根治术的53例局部进展期低位直肠癌患者临床资料,纳入观察组。分析两组患者病灶切除情况(R0切除、R1切除、R2切除),比较治疗前和术后1周两组患者肛肠动力学[直肠静息压(RRP)、直肠最大耐受容量(MTV)、直肠顺应性(RC)]、恶性肿瘤标志物[癌胚抗原(CEA)、糖类抗原199(CA199)、肿瘤型M2丙酮酸激酶(TuM2-PK)]水平、免疫细胞[T淋巴细胞(CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+))]。结果:观察组R0切除率大于对照组(P<0.05);术后1周,两组患者RRP水平较治疗前升高,但观察组低于对照组,MTV及RC水平均较治疗前降低,但观察组高于对照组(P均<0.05);CEA、CA199及TuM2-PK水平均较治疗前降低,观察组低于对照组(P均<0.05);观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平较治疗前降低(P均<0.05),对照组无显著性变化(P均>0.05),且两组差异具有统计学意义(P均<0.05)。结论:XELOX新辅助化疗可提高部进展期低位直肠癌根治术患者R0切除率,改善患者肛肠动力学,降低恶性肿瘤标志物水平,但会降低患者免疫功能。

Objective:To explore the effects of XELOX neoadjuvant chemotherapy on the R0 resection rate and levels of malignant tumor markers in patients with locally progressive low rectal cancer undergoing radical resection.Methods:Clinical data of 52 patients with locally progressive low rectal cancer who received radical resection in the hospital from August 2019 to August 2022 were retrospectively analyzed and the patients were included in control group.Clinical data of 53 patients with locally progressive low rectal cancer who underwent XELOX neoadjuvant chemotherapy+radical resection in the hospital during the same period were retrospectively analyzed and the patients were enrolled as observation group.The lesion resection status(R0 resection,R1 resection,R2 resection)in the two groups were analyzed.Anorectal dynamics[rectal resting pressure(RRP),rectal maximum tolerance volume(MTV),rectal compliance(RC)],malignant tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),tumor M2 pyruvate kinase(TuM2-PK)]and immune cells[T lymphocytes(CD3^(+),CD4^(+),CD4^(+)/CD8^(+))]were compared between the two groups of patients before treatment and one week after surgery.Results:The R0 resection rate in observation group was higher than that in control group(P<0.05).One week after surgery,RRP in both groups was enhanced compared with that before treatment,but the RRP in observation group was lower than that in control group,and MTV and RC were reduced compared with those before treatment,but the two indicators in observation group were higher than those in control group(all P<0.05).The levels of CEA,CA199 and Tu M2-PK were declined compared to before treatment,and the levels were lower in observation group(all P<0.05).The levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in observation group were declined compared with those before treatment(all P<0.05),but there were no significant changes in control group(all P>0.05),and the differences between the two groups were statistically significant(all P<0.05).Conclusion:XELOX neoadjuvant chemotherapy can enhance the R0 resection rate,improve the anorectal dynamics and reduce the levels of malignant tumor markers in patients with locally progressive low rectal cancer undergoing radical resection,but it can reduce the immune function of patients.