局部晚期直肠癌术前新辅助放化疗后ypT1～4N0期患者术后辅助化疗的价值  

Value of postoperative adjuvant chemotherapy in locally advanced rectal cancer patients with ypT1- 4N0 after neo-adjuvant chemoradiotherapy

作　　者：游凯云[1] 彭海花[2] 高远红[1] 陈利[1] 周冠群[1] 常晖[1] 杜晓京[1] 肖林[1] 曾智帆[1] 文碧秀[2] 刘孟忠[1] 

机构地区：[1]华南肿瘤学国家重点实验室 中山大学肿瘤防治中心放射治疗科,广州510060 [2]中山大学附属第一医院放射治疗科

出　　处：《中华肿瘤杂志》2013年第9期708-713,共6页Chinese Journal of Oncology

基　　金：国家自然科学基金（81071891）;广东省科技计划项目（2010B0807017）

摘　　要：目的探讨局部晚期直肠癌术前新辅助放化疗后ypT1—4N0期患者术后辅助化疗的价值。方法收集2003年3月至2010年12月间，经术前同期放化疗及根治性手术后病理检查证实为ypT1—4N0期的局部晚期直肠癌患者104例，其中术后辅助化疗73例，术后未化疗31例；ypT1～2期39例，ypT3～4期65例。对全组患者和亚组患者进行生存分析。结果中位随访时间为41个月。全组104例ypT1～4N0期患者的3年总生存率和无复发生存率分别为93．4％和85．3％，其中术后辅助化疗组患者的3年总生存率和无复发生存率分别为95．5％和88．6％；术后未化疗组患者的3年总生存率和3年无复发生存率分别为88．6％和77．2％。术后辅助化疗组与术后未化疗组患者总生存曲线和无复发生存曲线的差异均无统计学意义（P值分别为0．106和0．108）。术后辅助化疗组患者的3年局部复发率和远处转移率分别为4．1％（3／73）和5．5％（4／73）；术后未化疗组患者的3年局部复发率和远处转移率分别为3．2％（1／31）和16．1％（5／31）。术后辅助化疗组与术后未化疗组患者的局部复发差异无统计学意义（P=0．676），远处转移差异有统计学意义（P=0．030）。亚组分析的结果显示，在ypT1～2N0期患者中，术后辅助化疗组与术后未化疗组患者的总生存曲线和无复发生存曲线的差异均无统计学意义（P值分别为0．296和0．939），术后辅助化疗组与术后未化疗组患者的局部复发和远处转移差异均无统计学意义（P值分别为0．676和0．414）。在ypT3～4N0期患者中，术后辅助化疗组与术后未化疗组患者的总生存曲线和无复发生存曲线的差异均有统计学意义（P值分别为0．034和0．025）。术后辅助化疗组与术后未化疗组患者的局部复发差异无统计学意义（P=0．548），远处转移差异有统计学意义（P=0．010）。结论术后辅助�Objective The purpose of this study was to investigate the value of postoperative chemotherapy for locally advanced rectal cancer patients who reached pathological ypT1-4N0 after neoadjuvant chemoradiotherapy. Methods We performed a retrospective study of 104 patients treated with preoperative chemoradiotherapy followed by radical resection, who achieved pathological ypT1-4N0, between Mar 2003 and Dec 2010. There were 73 patients who received postoperative adjuvant chemotherapy, and the other 31 patients did not. The distribution of final pathologic stages for these patients was ypT1-2N0 in 39 cases and ypT3-4N0 in 65 cases. Results The median follow-up was 41 months. The 3-year overall survival rate （OS） and recurrence-free survival rate （RFS） for the whole group （ypT1-4N0） were 93.4% and 85.3% , respectively. The 3-year OS and RFS in the adjuvant chemotherapy group and non-adjuvant chemotherapy group were 95.5% , 88.6% and 88.6% , 77.2%, respectively. There were no significant differences in 3-year RFS （P = 0. 108） and OS （P = 0. 106） between the two groups. The 3-year local recurrence and distant metastasis rates in the adjuvant chemotherapy group were 4.1% （3/73）and 5.5% （4/73）, while for the non-adjuvant chemotherapy group, the 3-year local recurrence rate and distant metastasis rate were 3.2% （1/31） and 16.1% （5/31）, respectively. Significant difference was found in distant metastasis rates （P =0.030）between the two groups, but not in local recurrence rates（P =0. 676）. Further subgroup analysis indicated that for the ypT1-2N0 patients, there were no significant differences in 3-year OS （ P = 0. 296） and RFS （ P = 0. 939 ） between the adjuvant and non-adjuvant chemotherapy groups, while negative results displayed in 3-year local recurrence rates （P = 0. 676） and distant metastasis rates （P = 0.414）. However, for patients with ypT3-4N0, significant differences were showed in both the 3-year OS （ P = 0. 034 ） and RFS （ P = 0. 025 ）, and furthe

关 键 词：直肠肿瘤 肿瘤分期 新辅助放化疗 术后辅助化疗 预后 

分 类 号：R735.3[医药卫生—肿瘤]