[an error occurred while processing this directive]|[an error occurred while processing this directive]
局部进展期中低位直肠癌新辅助放化疗临床疗效及预后影响因素分析
刘燕, 吕茵, 陆艳荣, 肖楠, 吴万艳, 张瑾熔
830011 乌鲁木齐,新疆医科大学第三临床医学院(附属肿瘤医院)胸腹放疗科
Clinical efficacy and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced low and middle rectal cancer
Liu Yan, Lyu Yin, Lu Yanrong, Xiao Nan, Wu Wanyan, Zhang Jinrong
Department of Thoracic and Abdominal Radiotherapy,the Third Clinical Medical College of Xinjiang Medical University (the Affiliated Cancer Hospital),Urumqi 830011,Xinjiang,China
Abstract：Objective To investigate the clinical efficacy of neoadjuvant chemoradiotherapy in the treatment of locally advanced low and middle rectal cancer,and evaluate the effect of related clinical factors upon the long-term survival. Methods Clinical data of 101 patients with locally advanced low and middle rectal cancer admitted to our hospital from January 1,2010 to December 31,2014 were collected. All patients completed the preoperative intensity-modulated radiation therapy DT45-50.4 Gy,synchronized with oxaliplatin+capecitabine/5-fluorouracil or single drug capecitabine chemotherapy,and total mesorectal excision) was performed 4-13 weeks after the end of the neoadjuvant therapy. The short-term efficacy and long-term prognosis of these patients were evaluated. Kaplan-Meier method was used for survival analysis,and Cox’s regression model for multivariate analysis. Results The total sphincter preservation rate was 53.5%.The decrease rates of T,N staging and TNM total staging were 73.26%,67.32% and 72.3%,respectively. The pathological complete response (pCR) rate was 16.8%.The median follow-up time was 41 months. The 3-year overall survival (OS), desease-free survival (DFS),local recurrence and distant metastases rates were 82.2%,80.7%,7.2% and 12.1%,respectively. The single factor analysis demonstrated that ypT and ypN stages were the risk factors affecting the 3-year OS,DFS anddistant metastases (all P<0.05).Multivariate analysis revealed that ypT stage was an independent factor affecting the 3-year OS,and ypT and ypN stages were the independent factors of the 3-year DFS (all P<0.05). Conclusions Neoadjuvant chemoradiotherapy combined with TME in the treatment of locally advanced middle and low rectal cancer can partially decrease the tumor staging,enhance the sphincter preservation rate and improve long-term clinical prognosis. Both ypT and ypN stages are correlated with the clinical prognosis of patients.
Liu Yan,Lyu Yin,Lu Yanrong et al. Clinical efficacy and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced low and middle rectal cancer[J]. Chinese Journal of Radiation Oncology, 2018, 27(12): 1066-1071.
[1] 陈万青,孙可欣,郑荣寿,等.2014年中国分地区恶性肿瘤发病和死亡分析[J].中华肿瘤杂志,2018,27(1):1-14.DOI:10.11735/j.issn.1004-0242.2018.01.A001. Chen WQ,Sun KX,Zheng RS,et al. Analysis of incidence and mortality of malignant tumors in China in 2014[J].Chin JOncol,2018,27(1):1-14.DOI:10.11735/j.issn.1004-0242.2018.01.A001. [2] Chau I,Brown G,Cunningham D,et al. Neoadjuvant capecitabine and oxaliplatin followed by synchronous chemoradiation and total mesorectal excision in magnetic resonance maging-defined poor-risk rectal cancer[J].J Clin Oncol,2006,24(4):668-674. DOI:10.1200/JCO.2005.04.4875. [3] Roh MS,Colangelo LH,O′Connell MJ,et al. Preoperative multimodality therapy improves disease-free survival in patients with carcinoma of the rectum:NSABP R-03[J].J ClinOncol,2009,27(31):5124-5130.DOI:10.1200/JCO.2009.22.0467. [4] Sauer R,Becker H,HohenbergerW,et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer[J].N EnglJMed,2004,351(17):1731-1740.DOI:10.1056/NEJMoa040694. [5] Fiorica F,Cartei F,Licata A,et al. Can chemotherapy concomitantly delivered with radiotherapy improve survival of patients with resectable rectal cancer? A meta-analysis of literature data[J].Cancer Treat Rev,2010,36(7):539-549.DOI:10.1016/j.ctrv.2010.03.002. [6] Calvo FA,Morillo V,Santos M,et al. Interval between neoadjuvant treatment and definitive surgery in locally advanced rectal cancer:impact on response and oncologic outcomes[J].J Cancer Res Clin Oncol,2014,140(10):1651-1660.DOI:10.1007/s00432-014-1718-z. [7] Lim T,Law WL,Liu,et al. Impact of neoadjuvant treatment on total mesorectal Excision for ultra-low rectal cancer[J].World J Surg Oncol,2010,8(1):23.DOI:10.1186/1477-7819-8-23. [8] 陈国华,宋新江,韩利红,等.新辅助治疗用于老年进展期直肠癌患者的临床研究[J].肿瘤学杂志,2014,20(9):770-772.DOI:10.11735/j.issn.1671-170X.2014.09.B018. Chen G,Song XJ,Han LH,et al. The clinical study of neoadjuvant therapy for elderly patients with advanced rectal cancer[J].J Oncol,2014,20(9):770-772.DOI:10.11735/j.issn.1671-170X.2014.09.B018. [9] 赵志勇,凌丽,鲁晓波,等.新辅助化疗联合腹腔镜手术治疗低位直肠癌的效果观察[J].临床合理用药杂志,2015,8(19):46-47.DOI:10.15887/j.cnki.13-1389/r.2015.19.031. Zhao ZY,Lingl,Lu XB,et al. The efficacy of neoadjuvant chemotherapy combined with laparoscopy in the treatment of low rectal cancer[J].J Clin Rational Use Drug,2015,8(19):46-47.DOI:10.15887/j.cnki.13-1389/r.2015.19.031. [10] Ho WM,Ma B,Mok T,et alLiver resection after irinotecan,5-flourouracil and folinic acid for patients with unresectable colorectal liver metastases:A multicenter phase Ⅱ study by the Cancer TherapeuticResearchGroup[J].Med0ncol,2005,22(3):303-312.DOI:10.1385/MO:22:3:303. [11] Sauer R,Liersch T,Merkel S,et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer:results of the German CAO/ARO/AIO 94 randomized phase Ⅲ trial after a median follow up of 11 years[J].Clin Oncol,2012,30(16):1926-1933.DOI:10.1200/JCO.2011.40.1836. [12] 肖毅,陆君阳,仲光熙,等.直肠癌新辅助强化治疗后肿瘤降期状况与生存预后[J].中华胃肠外科杂志,2014,17(6):547-550.DOI:10.3760/cma.j.issn.1671-0274.2014.06.007. Xiao Y,Lu JY,Zhong GX,et al. Tumor descending status and survival after neoadjuvantintensive treatment of rectal cancer[J].Chin J Gastroenterol Surg,2014,17(6):547-550.DOI:10.3760/cma.j.issn.1671-0274.2014.06.007. [13] 孙艳武,池畔,徐本华,等.直肠癌新辅助放化疗后病理完全缓解预测因素分析[J].中华胃肠外科杂志,2014,17(6):556-560.DOI:10.3760/cma.j.issn.1671-0274.2014.06.009. Sun YW,Chi B,Xu BH,et al. Analysis of predictive factors for complete remission of the rectal cancer after neoadjuvant chemoradiotherapy[J].Chin J Gastroenterol Surg,2014,17(6):556-560.DOI:10.3760/cma.j.issn.1671-0274.2014.06.009. [14] 林培煜,术前新辅助同步放化疗治疗Ⅱ、Ⅲ期直肠癌疗效的Meta分析[J].广西医学,2016,38(4):506-510.DOI:10.11675/j.issn.0253-4304.2016.04.17. Lin PY,Preoperative neoadjuvant concurrent chemoradiotherapy in the treatment of stage Ⅱ and Ⅲ rectal cancer:Meta analysis[J].Guangxi Med,2016,38(4):506-510.DOI:10.11675/j.issn.0253-4304.2016.04.17. [15] Capirci C,Valentini V,Cionini L,et al. Prognostic value of pathologic complete response afterneoadjuvant therapy in locally advanced rectal cancer:long-term analysis of 566 ypCR patients[J].Int J Radiat Oncol Biol Phys,2008,72(1):99-107.DOI:10.1016/j.ijrobp.2007.12.019. [16] De Campos-Lobato LF,Stocchi L,da Luz Moreira A,et al. Pathologic complete response after neoadjuvant treatment for rectal cancer decreases distant recurrence and could eradicate local recurrence[J].Ann SurgOncol,2011,18,(6):1590-1598.DOI:10.1245/s10434-010-1506-1. [17] Gérard JP,Conroy T,Bonnetain F,et alPreoperative radiotherapy with or without concurrent fluorouracil and leucovorin in T3-4 rectal cancers:results of FFCD 9203[J].JClinOncol,2006,24(28):4620-4625.DOI:10.1200/JCO.2006.06.7629. [18] Quah HM,Chou JF,Gonen M,et al. Pathologic stage is most prognostic of disease-free survival in locally advanced rectal cancer patients after preoperative chemoradiation[J].Cancer,2008,113(1):57–64.DOI:10.1002/cncr.23516. [19] Koca D,Binicier C,Yilmaz U,et al. Prognostic factors affecting recurrence and survival in patients with locally advanced rectal cancer[J].J BUON,2012,17(2):291-298.MEDLINE PMID22740208. [20] Park IJ,You YN,Agarwal A,et al. Neoadjuvant treatment response as an early response indicator for patients with rectal cancer[J].Clin Oncol,2012,30(15):1770–1776.DOI:10.1200/JCO.2011.39.7901.
2018, Vol. 27 
