局部进展期中低位直肠癌单纯新辅助化疗与新辅助放化疗的疗效比较

Comparison of the efficacy of neoadjuvant chemotherapy versus neoadjuvant chemoradiotherapy in locally advanced mid-low rectal cancer

目的探讨局部进展期中低位直肠癌患者接受以氟尿嘧啶类药物为基础的单纯新辅助化疗(mFOLFOX6/CapeOX)与新辅助放化疗的疗效和远期预后差异,比较两组的治疗效果。方法回顾性分析2019年1月至2021年12月在西安交通大学第一附属医院接受单纯新辅助化疗和新辅助放化疗的共118例局部进展期中低位直肠癌患者的性别、年龄、身体质量指数(BMI)等临床病理资料。分别采用t检验、Mann Whitney检验、卡方检验或Fisher精确检验比较接受单纯新辅助化疗与新辅助放化疗两组患者之间在短期疗效、淋巴结检出数目和远期预后之间的差异。采用Kaplan-Meier法计算生存率并绘制生存曲线。结果在疗效方面,新辅助放化疗组患者获得更好的肿瘤退缩(Z=―2.05,P=0.04)和实体肿瘤疗效(Z=―2.42,P=0.015),但两组在降低临床分期方面的差异无统计学意义。新辅助放化疗组的淋巴结检出数明显降低(单纯新辅助化疗组vs.新辅助放化疗组,13.19±3.83 vs.9.55±4.00,t=5.02,P<0.001),但两组在淋巴结阳性数和淋巴结阳性比之间的差异无统计学意义。在远期预后方面,两组患者总生存率和无病生存率之间的差异无统计学意义。结论与单纯新辅助化疗相比,新辅助放化疗对局部进展期中低位直肠癌患者的短期疗效更佳,但两种治疗方案在远期预后方面差异无统计学意义。

Objective To investigate the differences in efficacy and long-term prognosis between locally progressive low and intermediate rectal cancer patients receiving fluorouracil-based neoadjuvant chemotherapy alone(mFOLFOX6/CapeOX) and neoadjuvant radiotherapy,and to compare the therapeutic efficacy in the two groups.Methods We retrospectively analyzed the clinicopathological data of 118 patients with locally progressive low and intermediate rectal cancer who received neoadjuvant therapy from January 2019 to December 2021 at The First Affiliated Hospital of Xi'an Jiaotong University,including gender,age,body mass index(BMI),and other clinicopathological parameters.The t-test,Mann Whitney test,chi-square test or Fisher's exact test were used to compare the differences between the two groups of patients who received neoadjuvant chemotherapy alone or neoadjuvant radiochemotherapy in terms of short-term efficacy,lymph node manifestations and long-term prognosis,respectively.Survival rates were calculated and survival curves were plotted using the Kaplan-Meier method.Results In terms of efficacy,patients in the neoadjuvant radiotherapy group achieved better tumor regression(Z=-2.05,P=0.04) and solid tumor efficacy(Z=-2.42,P=0.015),but the difference between the two groups in terms of downstaging effect of clinical stage was not statistically significant.The number of lymph nodes detected was significantly lower in the neoadjuvant radiotherapy group(neoadjuvant chemotherapy vs.neoadjuvant radiochemotherapy,13.19±3.83 vs.9.55±4.00,t=5.02,P<0.001),but the two groups did not differ significantly in the number of lymph node positives and lymph node positive ratio.In terms of long-term prognosis,there was no statistically significant difference in the overall survival rate or disease-free survival rate of the two groups.Conclusion Compared with neoadjuvant chemotherapy alone,neoadjuvant radiotherapy showed better short-term efficacy in patients with locally progressive low and intermediate rectal cancer,but there was no statistically significant difference between the two treatment regimens in terms of long-term prognosis.