局部晚期直肠癌新辅助放化疗术后病理分期对预后影响  

Prognostic effects of pathological stages in patients with locally advanced rectal cancer after neoadjuvant radiochemotherapy plus radical surgery

作　　者：彭海花[1] 游凯云[2] 王成涛[1] 黄蓉[2] 常晖[2] 周冠群[2] 曾智帆[2] 刘孟忠[2] 文碧秀[1] 高远红[1] 

机构地区：[1]中山大学附属第一医院放疗科,广州510080 [2]华南肿瘤学国家重点实验室中山大学肿瘤防治中心放疗科,广州510060

出　　处：《中华放射肿瘤学杂志》2013年第6期439-442,共4页Chinese Journal of Radiation Oncology

基　　金：国家自然科学基金（81071891,81172209）;广东省科技计划项目（2010B0807017,2010B031600090）

摘　　要：目的 探讨局部晚期直肠癌新辅助放化疗（neo-RCT）根治术后病理分期对预后影响.方法 回顾分析2003-2010年收治的210例局部晚期直肠癌neo-RCT术后患者的临床资料,其中Neo-RCT术后ypT0～2N（-）、ypT3 ～4N（-）、ypT0～4N（＋）期患者分别为91、69、50例.Kaplan-Meier法计算生存率并Logrank法检验和单因素分析影响无复发生存因素,Cox法多因素分析影响无复发生存因素.结果 随访率99％,随访时间满5年者64例.Neo-RCT术后ypT0～2N（-）、ypT3 ～4N（-）、ypT0～4N（＋）期患者5年总生存率分别为88％、75％、65％ （P =0.018）、无复发生存率分别为81％、78％、60％ （P =0.005）、无远处转移生存率分别为91％、81％、64％ （P =0.000）.多因素分析显示术后病理N分期是影响无复发生存的独立因素.结论 局部晚期直肠癌neo-RCT术后病理分期是影响预后的重要因素,根据病理分期进行个体化术后辅助治疗具有现实的临床意义.Objective To investigate the prognostic effects of pathological stages in patients with locally advanced rectal cancer after neoadjuvant radiochemotherapy （Neo-RCT） plus radical surgery.Methods A retrospective analysis was performed on the clinical data of 210 patients with locally advanced rectal cancer who were admitted to our hospital from 2003 to 2010 and were treated with Neo-RCT followed by radical surgery.After Neo-RCT plus radical surgery,the pathological stages included ypT0-2 N （-） （91patients,43.3%）,ypT3-4N （-） （69 patients,32.9%）,and ypT0-4N （＋） （50 patients,23.8%）.The Kaplan-Meier method was used for calculating survival rates ;the log-rank test was used for survival difference analysis and univariate analysis of prognostic factors for disease free survival （DFS） ; the Cox proportional hazard model was used for multivariate analysis of prognostic factors for DFS.Results The follow-up rate was 99%,and 64 patients were followed up for at least 5 years.After Neo-RCT plus radical surgery,the patients with ypT0-2 N （-）,ypT3-4N （-）,and ypT0-4N （＋） rectal cancers had 5-year overall survival rates of 88%,75%,and 65%,respectively （P=0.018）,5-year DFS rates of 81%,78%,and 60%,respectively （P =0.005）,and 5-year distant metastasis-free survival rates of 91%,81%,and 64% （P =0.000）.The multivariate analysis showed that ypN stage was the independent prognostic factor for DFS.Conclusions Pathological stage is strongly associated with the treatment outcome in patients with locally advanced rectal cancer treated with Neo-RCT followed by radical surgery,which may be used as guidance for postoperative individualized adjuvant therapy.

关 键 词：直肠肿瘤 新辅助放化疗法 临床分期 病理分期 预后 

分 类 号：R735.3[医药卫生—肿瘤]