论文部分内容阅读
目的:探讨术前同步放化疗联合全直肠系膜切除术治疗Ⅱ/Ⅲ期中低位直肠癌的临床疗效和安全性。方法:回顾性收集新疆医科大学附属肿瘤医院2008年1月1日至2014年12月31日收治的181例接受术前同步放化疗的Ⅱ/Ⅲ期中低位直肠癌患者的临床资料,术前放疗为50 Gy/(25 f·35 d),共5周完成,同步化疗方案包括XELOX、FOLFOX及单药卡培他滨等,术前化疗2~5周期,所有患者在同步放化疗治疗结束6~8周后手术,遵循全直肠系膜切除术(total mesorectal excision,TME)原则。147例患者行术后辅助化疗。用Kaplan-Meier法计算总生存率(overall survival,OS),局部复发率(local recurrence rate,LRR),远处转移率(distant metastasis rate,DMR),并用Cox模型对预后的影响因素进行多因素分析。结果:181例患者均完成同步放化疗,行经腹直肠癌切除、近端造口、远端封闭手术(Hartmann)2例,低位前切除术(Dxion)108例、腹会阴联合切除术(Mile’s)71例。原发肿瘤T分期、N分期及TNM分期的降期率分别为49.7%、82.9%、54.1%。病理完全缓解率为10.5%(19/181)。术前同步放化疗Ⅲ级不良反应为6.8%,术后累计并发症发生率为22.7%。同步XELOX、FOLFOX及单药卡培他滨5年OS分别为69.66%、62.75%、63.41%,差异有统计学意义(P=0.000)。5年DMR分别为17.1%、32.7%、24.5%,差异有统计学意义(P=0.000)。5年LRR分别为3.9%、5.8%、3.8%,差异无统计学意义(P=0.108)。肿瘤占肠周值及术后病理分期是预后影响因素。结论:术前同步放化疗能提高R0切除率和保肛率,肿瘤降期明显,治疗相关的急性不良反应及术后并发症的发生率较低。同步XELOX方案化疗5年OS要高于FOLFOX及单药卡培他滨,且5年DMR率要低于同步FOLFOX及单药卡培他滨。
Objective: To investigate the clinical efficacy and safety of preoperative chemoradiotherapy combined with total mesorectal excision in the treatment of stage Ⅱ / Ⅲ lower rectal cancer. Methods: The clinical data of 181 patients with stage Ⅱ / Ⅲ low rectal cancer undergoing preoperative concurrent chemoradiotherapy from Cancer Hospital Affiliated to Xinjiang Medical University from January 1, 2008 to December 31, 2014 were retrospectively collected. Preoperative radiotherapy 50 Gy / (25 f · 35 d) for 5 weeks. The concurrent chemotherapeutic regimens included XELOX, FOLFOX and single-drug capecitabine. All patients underwent 2 to 5 cycles of preoperative chemotherapy and all patients underwent concurrent chemoradiotherapy After ~ 8 weeks of surgery, follow the principle of total mesorectal excision (TME). 147 patients underwent postoperative adjuvant chemotherapy. The overall survival (OS), local recurrence rate (LRR) and distant metastasis rate (DMR) were calculated by Kaplan-Meier method, and the factors influencing the prognosis were analyzed by multiple factors analysis. Results: All 181 patients underwent concurrent chemoradiotherapy. Two cases of resection of abdominal rectal cancer, proximal stoma, distal occlusion (Hartmann), 108 cases of low anterior resection (Dxion), Mile’s 71 cases. The primary tumor T stage, N stage and TNM staging down rate was 49.7%, 82.9%, 54.1%. The complete pathological response rate was 10.5% (19/181). Preoperative synchronous chemoradiotherapy Ⅲ grade adverse reactions were 6.8%, the cumulative incidence of postoperative complications was 22.7%. The 5-year OS of synchronous XELOX, FOLFOX and single-drug capecitabine were 69.66%, 62.75% and 63.41%, respectively. The difference was statistically significant (P = 0.000). The 5-year DMR were 17.1%, 32.7% and 24.5% respectively, with significant difference (P = 0.000). The 5-year LRR was 3.9%, 5.8% and 3.8% respectively, with no significant difference (P = 0.108). Tumor accounting for intestinal periarthritis and postoperative pathological stage are prognostic factors. Conclusions: Preoperative chemoradiotherapy can improve the rate of R0 resection and anal sphincter preservation. The reduction of tumor is significant, and the treatment-related acute adverse reactions and the incidence of postoperative complications are low. The 5-year OS of concurrent XELOX chemotherapy was higher than that of FOLFOX and single-agent capecitabine, and the 5-year DMR rate was lower than that of concurrent FOLFOX and single-drug capecitabine.