单纯新辅助化疗治疗进展期低位直肠癌的疗效分析

Efficacy analysis of neoadjuvant chemotherapy alone in the treatment of advanced low rectal cancer

目的:评价单纯新辅助化疗治疗进展期低位直肠癌的疗效,同时探索新辅助化疗对直肠癌患者术后低位前切除综合征(low anterior resection syndrome,LARS)发生率的影响。方法:回顾性分析2012年01月01日至2021年01月01日,我院普通外科治疗的临床进展期且接受腹腔镜根治术的60例直肠癌患者临床资料。根据患者是否接受新辅助化疗分为新辅助化疗(NACT)组和辅助化疗(ACT)组。回顾性分析对比各组病人的一般临床资料、化疗不良反应、手术并发症、手术时长、手术出血量、住院时长、住院费用、肿瘤标志物转阴率、肿瘤缓解率、肿瘤降期率、化疗后肿瘤反应等级、术后无病生存曲线、总生存曲线,术后1、3、6、12个月的LARS评分。结果:NACT组与ACT组相比,两组在手术并发症、术后排气时间、住院时长上均没有统计学差异(P>0.05);在化疗不良反应、术后CEA、CA19-9转阴率、手术时长、手术出血量、住院费用上NACT组要明显优于ACT组(P<0.05);在DFS、OS生存曲线上,随着时间的延长,NACT生存曲线下降的幅度小于ACT组,其中DFS生存曲线有明显统计学差异(P<0.05),OS生存曲线无明显统计学差异(P>0.05);NACT组患者术后不同阶段的LARS评分与ACT组均无明显统计学差异(P>0.05),两组患者在术后1年的LARS评分下降最为明显(P>0.05)。结论:仅用新辅助化疗同样可明显改善直肠癌患者的预后,同时并不会影响术后LARS的发生率以及严重程度。

Objective:To evaluate the efficacy of neoadjuvant chemotherapy alone for advanced low rectal cancer,and to explore the effect of neoadjuvant chemotherapy on the incidence of LARS in rectal cancer patients after surgery.Methods:Retrospective analysis of the clinical data of 60 patients with rectal cancer who received laparoscopic radical surgery during the clinical progression period from January 1,2012 to January 1,2021 in general surgery of our hospital.Patients were divided into neoadjuvant chemotherapy(NACT)and adjuvant chemotherapy(ACT)groups according to whether they received neoadjuvant chemotherapy.The general clinical data,side effects of chemotherapy,operative complications,operative duration,operative bleeding,length of stay,hospitalization expenses,negative rate of tumor markers,remission rate of tumor,reduction rate of tumor stage,grade of tumor reaction after chemotherapy,disease-free survival curve and overall survival curve were analyzed and compared retrospectively,LARS scores at 1,3,6,12 months after surgery.Results:There was no significant difference between the NACT group and the ACT group in operative complications,postoperative exhaust time and length of hospital stay(P>0.05).NACT group was significantly superior to ACT group in terms of adverse reaction of chemotherapy,negative conversion rate of CEA and CA19-9 after operation,operation time,blood loss and hospital cost(P<0.05).On the DFS and OS survival curves,as time went on,the NACT survival curve decreased less than the ACT group,and the DFS survival curve had significant difference(P<0.05),but the OS survival curve had no significant difference(P>0.05).There was no significant difference between the NACT group and the ACT group in LARS scores at different stages after surgery(P>0.05),and the decrease in LARS scores was the most significant in both groups at 1 year after surgery(P>0.05).Conclusion:Neoadjuvant chemotherapy alone also significantly improved the outcome of patients with rectal cancer,without affecting the incidence and severity of LARS after surgery.