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目的:评估Ⅱ-Ⅲ期直肠癌4种治疗策略疗效的差异并行预后分析.方法:回顾性分析2010-01/2013-12以氟尿嘧啶为基础同步放化疗的Ⅱ-Ⅲ期直肠癌的230例患者临床资料,其中新辅助放化疗联合手术68例(A组)、术后辅助放化疗70例(B组)、新辅助放化疗未手术51例(C组)、根治性放化疗41例(D组).(新)辅助放疗剂量50 Gy/25次,根治性放疗剂量60-66 Gy/30-33次,手术方式为全直肠系膜切除术,放疗与手术的间期为4-8 wk.结果:全组随访率93.4%,144例随访满3年.局部复发53例,远处转移44例(P值分别为0.602,0.073);3年总生存率(overall survival,OS)和无病生存率(disease-free survival,DFS)差异有统计学意义(P=0.001和0.004),A组OS(86.76%)和DFS(76.27%)均高于其他3组.A组和B组肿瘤完全切除(R0)率为98.5%、78.5%.全组急性不良反应多为1-2级.多因素分析,治疗方式中新辅助放化疗(P=0.002)、年龄(P=0.021)及全周肿瘤(P=0.029)是预后因素.结论:新辅助放化疗联合手术R0切除率较高,并且OS和DFS较高,是Ⅱ-Ⅲ期直肠癌有效的治疗方法.新辅助放化疗未手术、年龄及全周肿瘤是预后因素.
PURPOSE: To evaluate the differences in the efficacy of four therapeutic strategies for stage Ⅱ-Ⅲ colorectal cancer.Methods: A retrospective analysis of 230 patients with stage Ⅱ-Ⅲ colorectal cancer treated with fluorouracil-based chemoradiotherapy from January 2010 to December 2013 was retrospectively performed Clinical data included 68 cases of neoadjuvant chemoradiation combined surgery (group A), 70 cases of adjuvant chemoradiotherapy (group B), 51 cases of neoadjuvant radiotherapy and chemotherapy (group C), and 41 cases of radical radiotherapy and chemotherapy (New) adjuvant radiotherapy dose of 50 Gy / 25 times, radical radiotherapy dose of 60-66 Gy / 30-33 times, the method of surgery for total mesorectal excision, radiotherapy and surgery interval of 4-8 wk. Results: The follow-up rate was 93.4% in the whole group and 3 years follow-up in 144 cases, with 53 cases of local recurrence and 44 cases of distant metastasis (P = 0.602, 0. 073 respectively); 3-year overall survival (OS) (P = 0.001 and 0.004), OS (86.76%) and DFS (76.27%) in group A were significantly higher than those in the other three groups.The complete tumor of group A and group B The rates of resection (R0) were 98.5% and 78.5%, respectively.The acute adverse reactions of the whole group were mostly grade 1-2.Multivariate analysis showed that the rates of neoadjuvant chemoradiation (P = 0.002), age Tumor (P = 0.029) was a prognostic factor. Conclusion: The neoadjuvant chemoradiation combined with surgery has a high R0 resection rate and a high OS and DFS, which is an effective treatment for patients with stage Ⅱ-Ⅲ colorectal cancer. Neoadjuvant radiotherapy and chemotherapy non-operation, age and whole-week tumor are prognostic factors.