新辅助放化疗与手术间隔时间对中晚期直肠癌患者疗效和生存的影响

Effect of time interval between neoadjuvant chemoradiotherapy and surgery on efficacy and survival of patients with advanced rectal cancer

目的探讨新辅助放化疗和手术治疗的时间间隔对中晚期直肠癌患者病理完全缓解(pathologic complete remission,p CR)、无瘤生存(disease free survival,DFS)和总生存(overall survival,OS)的影响。方法回顾性分析行术前同步放化疗联合全直肠系膜切除术治疗且随访≥36个月的100例ⅢA和ⅢB期直肠癌患者资料。新辅助放化疗与手术的间隔时间≤7周的46例患者为研究组,> 7周的54例患者为对照组。比较两组治疗效果及术后3年生存情况。结果两组患者手术时间、术中输血人次、住院时间及术后并发症发生情况等比较,差异均无统计学意义(均P> 0. 05)。研究组p CR以及镜下切缘无癌残留切除率均低于对照组(6. 5%vs 21. 7%,82. 6%vs96. 3%,均P <0. 05)。研究组术后3年局部复发或转移率高于对照组(54. 3%vs 31. 5%),3年DFS低于对照组(28. 3%vs 55. 6%),差异均具有统计学意义(均P <0. 05)。两组3年OS比较,差异无统计学意义(P> 0. 05)。结论临床治疗ⅢA和ⅢB期直肠癌患者时,延长新辅助放化疗与手术之间的时间间隔可以提高手术切除效果、p CR和DFS,有效控制术后恶性肿瘤的局部复发与转移率,且不增加术后并发症发生率,但对OS无影响。

Objective To explore the influences of the time interval between neoadjuvant chemoradiotherapy and surgery on the pathologic complete remission( p CR),disease free survival( DFS) and overall survival( OS) of patients with advanced rectal cancer. Methods One-hundred patients with stage ⅢA and ⅢB rectal cancer who underwent preoperative chemoradiotherapy combined with total mesorectal excision and were followed up for ≥36 months were retrospectively analyzed. Patients with interval ≤7 weeks were included in the study group( n = 46),and those with interval > 7 weeks were included in the control group( n = 54). The therapeutic effects of the two groups and the 3-year postoperative survival rates were compared between the two groups. Results There were no significant differences in the operation time,intraoperative blood transfusion,hospitalization time and postoperative complications between the two groups( all P > 0. 05). Nevertheless,both p CR and R0 resection rate were lower in the study group than those in the control group( 6. 5% vs 21. 7%,82. 6% vs 96. 3%,both P < 0. 05). Moreover,the 3-year local recurrence or metastasis rate of the study group was also significantly higher than that of the control group( 54. 3% vs 31. 5%,P < 0. 05),yet its 3-year DFS was significantly lower than that of the control group( 28. 3% vs 55. 6%,P < 0. 05). Finally,no significant difference was observed in the 3-year OS between the two groups( P > 0. 05). Conclusion When clinically treating patients with stage Ⅲ A and Ⅲ B rectal cancer,increasing the time interval between neoadjuvant chemoradiotherapy and surgery can improve the outcome of surgical resection,p CR and DFS,and effectively control the local recurrence and metastasis rate of postoperative malignant tumors,without increasing the incidence of postoperative complications,but it has no effect on OS.