pT3 N0期直肠癌术后辅助放疗价值探讨  

Value of postoperative adjuvant radiotherapy for pT3 N0 rectal cancer

作　　者：王玉[1] 陈书[2] 吴生红[3] 陈路川[2] 柏朋刚[1] 邵凌东[1] 吴君心[1] 潘建基[1] 

机构地区：[1]福建医科大学教学医院福建省肿瘤医院放疗科,福州350014 [2]福建医科大学教学医院福建省肿瘤医院腹部外科,福州350014 [3]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《中华放射肿瘤学杂志》2015年第4期387-391,共5页Chinese Journal of Radiation Oncology

基　　金：国家临床重点专科建设项目（2013-2014）;福建省临床重床重点专科建设项目（2012）

摘　　要：目的：探讨 pT3 N0期直肠癌根治性切除术后辅助放疗价值。方法回顾分析2003—2010年期间本院诊断明确且行 TME 术的125例pT3 N0期直肠癌患者资料，所有患者均接受术后化疗，其中40例接受术后放疗。 Kaplan.Meier 法计算生存率，Logrank 法检验和单因素预后分析，Cox 法多因素分析影响 LR 因素。结果5年样本量为35例，5年OS 和 DFS 分别为82.3％和72.4％，术后放化疗和化疗的5年OS 分别为72％和83％（P＝0.911）。多因素分析送检淋巴结个数、肿瘤是否侵犯肠周脂肪是 LR 的影响因素（P＝0.045、0.021）。低危组（无高危因素）和高危组（≥1个） LR 率分别为2.5％和11.8％（P＝0.060）。结论对于无高危因素的 pT3 N0期直肠癌患者术后放疗未能改善OS、LR 率，对该期患者术后常规放疗有待探讨。Objective To evaluate the value of adjuvant radiotherapy after radical resection for pT3 N0 rectal cancer. Methods The clinical data of 125 patients with pT3 N0 rectal cancer who were diagnosed and given total mesorectal excision in our hospital from 2003 to 2010 were retrospectively analyzed. All patients received postoperative adjuvant chemotherapy, while 40 out of them received postoperative adjuvant radiotherapy in addition. Survival rates were estimated using the Kaplan.Meier method, and univariate prognostic analysis was performed using the log.rank test. Multivariate analysis of influencing factors for local recurrence （LR） rate was performed using the Cox regression model. Results The 5.year sample size was 35. The 5.year overall survival （OS） and disease.free survival （DFS） rates were 82. 3%and 72. 4%, respectively. There was no significant difference in the 5.year OS rate between the postoperative chemoradiotherapy group and the postoperative chemotherapy group （ 72% vs. 83%, P= 0. 911 ）. Multivariate analysis suggested that the number of lymph nodes and perirectal fat infiltration were independent prognostic factors for LR rate （P= 0. 045;P= 0. 021）. There was no significant difference in LR rate between the low.risk group （no high.risk factors） and the high.risk group （ the number of high.risk factors ≥1）（2. 5% vs. 11. 8%, P= 0. 060）. Conclusions Postoperative radiotherapy cannot improve the OS and LR rates for pT3 N0 rectal cancer without any high.risk factors. The value of postoperative adjuvant radiotherapy for pT3 N0 rectal cancer needs further evaluation.

关 键 词：直肠肿瘤/ 术后放射疗法 直肠肿瘤/ 术后化学疗法 预后因素 

分 类 号：R735.37[医药卫生—肿瘤]