控制营养状态评分预测局部进展期直肠癌病人肿瘤退缩及预后研究

Pretreatment control nutritional status score predicts tumor regression response and survival for locally advanced rectal cancer patients following neoadjuvant chemoradiotherapy

目的探讨控制营养状态(COUNT)评分与局部进展期直肠癌(LARC)病人接受新辅助放化疗(NCRT)后肿瘤退缩反应及术后生存的关系。方法回顾性分析2011年1月至2016年12月首都医科大学附属北京朝阳医院普通外科收治的接受NCRT的144例LARC病人的临床资料。根据NCRT前COUNT评分,将病人分为低COUNT组(COUNT评分≤2分,76例)和高COUNT组(COUNT评分>2分,68例)。比较两组病人临床病理特征及预后生存。结果两组病人在年龄、性别、BMI、肿瘤下缘距肛缘距离、cT和cN分期、治疗前癌胚抗原(CEA)、新辅助治疗方案、术式、手术时间、失血量、术后并发症方面差异无统计学意义(P>0.05)。术后病理学检查结果显示,两组病人ypN分期、ypTNM分期、淋巴结获取数、病理完全缓解(pCR)率、环周切缘(CRM)阳性率、脉管浸润和神经侵犯的差异无统计学意义(P>0.05)。与低COUNT组比较,高COUNT组病人接受NCRT后肿瘤退缩反应较差(41.2%vs.19.7%,P=0.005)。多因素分析显示,治疗前CEA≥5.0μg/L(HR=5.666,95%CI 2.351-13.658,P<0.001)、治疗前高COUNT评分(HR=2.510,95%CI 1.111-5.674,P=0.027)及单药口服化疗(HR=3.129,95%CI 1.312-7.466,P=0.010)是导致肿瘤退缩反应较差的独立危险因素。在术后生存方面,高COUNT组病人总体生存和无进展生存劣于低COUNT组(总体生存:HR=4.317,95%CI 1.228-15.169,P=0.023;无进展生存:HR=2.999,95%CI 1.352-6.652,P=0.007)。结论治疗前COUNT评分可用于预测LARC病人对NCRT的肿瘤退缩反应及预后生存,高COUNT评分可能预示较差的肿瘤退缩反应和预后生存。

Objective To explore whether control nutritional status(COUNT)score could predict tumor regression response and survival for locally advanced rectal cancer(LARC)patients following neoadjuvant chemoradiotherapy(NCRT).Methods Clinical and pathological characteristics of 144 patients who received NCRT for LARC admitted into the General Surgery Department of Beijing Chaoyang Hospital from January 2011 to December 2016 were retrospectively collected.The patients were divided into low-COUNT group(COUNT≤2,n=76)and high-COUNT group(COUNT>2,n=68).The clinical,pathological characteristics and survival outcomes of patients with different pretreatment COUNT score were compared.Results No significant differences were found in terms of age,gender,BMI,distance from anal verge,cT/N stage,pretreatment CEA,neoadjuvant treatment,type of surgery,operation time,blood loss and postoperative complications between two groups.Regarding pathological outcomes,no significant differences were found in ypN stage,ypTNM stage,lymph nodes harvested,pathological complete regression rate,positive circumferential resection margin rate,lymphatic vascular invasion and perineural nerve invasion between two groups.More patients in the high-COUNT group had poor pathological response than those in the low-COUNT group(41.2%vs.19.7%,P=0.005).Pretreatment CEA≥5.0μg/L(HR=5.666,95%CI 2.351-13.658,P=0.000),high COUNT score(HR=2.510,95%CI 1.111-5.674,P=0.027)and oral capecitabine alone(HR=3.129,95%CI 1.312-7.466,P=0.010)were considered as independent risk factors for predicting poor pathological response according to logistic multivariate analysis.In terms of survival outcomes,patients in the high-COUNT group had worse OS(HR=4.317,95%CI 1.228-15.169,P=0.023)and DFS(HR=2.999,95%CI 1.352-6.652,P=0.007)than those in the low-COUNT group.Conclusion As a score system of nutritional and immune status,COUNT score might predict the tumor regression response to NCRT and survival of LARC patients,and high-COUNT score might indicate low tumor regression response and survival.