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目的评价低位直肠癌根治术后置泵灌注化疗的疗效,探讨其临床应用价值,并对影响疗效的相关因素进行分析。方法回顾性分析1997年10月-2008年3月在解放军309医院接受手术治疗的低位直肠癌患者316例,根据根治术后采用的不同化疗方法分为两组:A组(手术加置泵组)249例,在直肠癌根治术中于髂内动脉置入化疗泵,术后行靶区灌注化疗及全身静脉化疗;B组(手术组)67例,行直肠癌根治术,仅在术后接受全身静脉化疗。A组靶区灌注化疗开始时间为术后12d胃肠功能恢复后,方案为氟尿嘧啶(0.5g/次)+羟喜树碱(10～15mg/次),每周2次,4次为1个疗程,共6个疗程。A组灌注化疗后行全身静脉化疗,采用FOLFIRI或FOLFOX方案,B组术后12d胃肠功能恢复后直接行全身静脉化疗(方案同A组)。观察患者1、3、5年局部复发率,远处转移率及生存率,分析A组患者临床病理特征与5年局部复发率及生存率的相关性。结果 A组1、3、5年局部复发率分别为0、1.68%(4/238)、3.79%(8/211),1、3、5年远处转移率为0.80%(2/249)、4.62%(11/238)、10.90%(23/211),1、3、5年生存率为100%、77.73%(185/238)、72.04%(152/211);B组1、3、5年局部复发率分别为0、9.52%(6/63)、16.36%(9/55),1、3、5年远处转移率为1.49%(1/67)、15.87%(10/63)、27.27%(15/55),1、3、5年生存率为100%(67/67)、58.73%(37/63)、52.73%(29/55)。两组1年局部复发率、远处转移率及生存率比较无统计学差异(P>0.05),A组3、5年局部复发率及远处转移率较低,3、5年生存率较高,两组比较差异有统计学意义(P<0.05)。肿瘤分化程度及Duke’s分期是5年局部复发率、远处转移率及生存率的影响因素。结论直肠癌根治术后置泵灌注化疗加全身静脉化疗可明显提高患者的长期生存率,降低5年局部复发率和转移率。肿瘤分化程度以及Duke’s分期也是影响患者疗效和生存的重要因素。
Objective To evaluate the curative effect of pump-infusion chemotherapy after radical resection of low rectal cancer and to explore its clinical value and analyze the related factors that affect curative effect. Methods A retrospective analysis of 316 patients with low rectal cancer undergoing surgical treatment at the People’s Liberation Army 309 Hospital from October 1997 to March 2008 was divided into two groups according to the different chemotherapy methods after radical operation: group A (operation plus pump group ) In 249 cases. In the radical resection of rectal cancer, a chemotherapy pump was inserted into the internal iliac artery. After the operation, perfusion chemotherapy and systemic vein chemotherapy were performed. In group B (operation group), 67 cases underwent radical resection of rectal cancer. Accept systemic vein chemotherapy. In group A, the target infusion chemotherapy started at 12 days after operation, and the regimen was fluorouracil (0.5g / time) and hydroxycamptothecin (10-15mg / time) twice a week for 4 times Course of treatment, a total of 6 courses. Group A received systemic chemotherapy after perfusion chemotherapy. FOLFIRI or FOLFOX regimen was used. Group B received systemic intravenous chemotherapy immediately after resumption of gastrointestinal function 12 days after surgery (protocol A). The recurrence rate, distant metastasis rate and survival rate of patients at 1, 3 and 5 years were observed. The correlation between clinicopathological characteristics and local recurrence rate and survival rate at 5 years was analyzed. Results The local recurrence rates at 1, 3, and 5 years in group A were 0, 1.68% (4/238) and 3.79% (8/211) respectively. The distant metastasis rates at 1, 3 and 5 years were 0.80% (2/249) , Respectively. The survival rates at 1, 3 and 5 years were 100%, 77.73% (185/238) and 72.04% (152/211), respectively , The local recurrence rates at 5 years were 0, 9.52% (6/63), 16.36% (9/55) respectively. The distant metastasis rates at 1, 3 and 5 years were 1.49% (1/67) and 15.87% (10 / 63 and 27.27%, respectively. The 1, 3, 5 year survival rates were 100% (67/67), 58.73% (37/63) and 52.73% (29/55) respectively. There was no significant difference in the local recurrence rate, distant metastasis rate and survival rate between the two groups at 1 year (P> 0.05). The recurrence rates at 3 and 5 years and the distant metastasis rate were lower in group A than those in group A High, the difference between the two groups was statistically significant (P <0.05). The degree of tumor differentiation and Duke’s staging are the influencing factors of 5-year local recurrence rate, distant metastasis rate and survival rate. CONCLUSION: Chemotherapy with pump and chemotherapy combined with systemic intravenous chemotherapy after radical resection of rectal cancer can significantly improve the long-term survival rate of patients and reduce the local recurrence rate and metastasis rate in 5 years. Tumor differentiation and Duke’s staging are also important factors that influence the efficacy and survival of patients.