不同原发部位转移性结直肠癌的化疗疗效差异分析  

Difference analysis of chemotherapy efficacy among different primary tumor sites in metastatic colorectal cancer

作　　者：孙志伟[1] 王晰程 贾军[1] 刘传玲[1] 张晓东[1] 沈琳[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华胃肠外科杂志》2016年第10期1119-1123,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨肿瘤原发部位与转移性结直肠癌化疗疗效的关系。方法回顾性收集1996年1月至2011年12月于北京大学肿瘤医院消化内科行一线及二线化疗的721例转移性结直肠癌患者的临床资料。按照肿瘤原发部位划分，其中回盲部61例（8．5％），升结肠或结肠肝曲126例（17．5％），横结肠或结肠脾曲26例（3．6％），降结肠或乙状结肠172例（23．9％），直肠336例（46．6％）。依据实体瘤疗效评价标准（RECIST）1．1版将化疗疗效分为完全缓解（CR）、部分缓解（PR）、病情稳定（SD）和疾病进展（PD），并计算总有效率（CR与PR例数之和／所有患者例数）。采用x^2检验比较不同原发部位转移性结直肠癌接受一线与二线化疗的疗效差异。结果接受一线化疗的571例患者中，无CR病例，190例（33．3％）为PR，277例（48．5％）为SD，104例（18．2％）为PD，总有效率为33.3％（190／571）。原发于回盲部、升结肠或结肠肝曲、横结肠或结肠脾曲、降结肠或乙状结肠、直肠的转移性结直肠癌有效率分别为21．3％（10／47）、35.3％（36／102）、14.3％（3／21）、41．3％（57／138）和31．9％（84／263），差异有统计学意义（P=0．028）。不同原发部位患者接受以奥沙利铂为基础的一线化疗方案，其疗效差异有统计学意义（P=0．009），而接受以伊立替康为基础的一线化疗和氟尿嘧啶单药一线化疗的疗效差异均无统计学意义（均P〉0．05）。原发灶位于横结肠或结肠脾曲的患者接受以伊立替康为基础的一线化疗方案，疗效明显优于以奥沙利铂为基础的方案和氟尿嘧啶单药，差异有统计学意义（P=0．042）；而原发灶位于其他部位患者接受不同方案一线化疗的疗效差异均无统计学意义（均P〉0．05）。接受二线化疗的352例患者中，无CR病例，43例（12．2％）为PR，186例（52．9％）为SD，1Objective To analyze the relationship between primary tumor location and clinical response of chemotherapy in patients with metastatic colorectal cancer（mCRC）. Methods Clinical data of 721 mCRC patients who received first-line and second-line chemotherapy in Peking University Cancer Hospital between January 1996 and December 201l were collected. All the patients were divided into 5 groups according to primary tumor location： ileocecum in 61 patients （8.5%）, ascending colon or hepatic flexure in 126 patients （17.5%）, transverse colon or splenic flexure in 26 patients （3.6%）, descending or sigmoid colon in 172 patients （23.9%）, rectum in 336 patients （46.6%）. Outcomes of chemotherapy were evaluated by Response Evaluation Criteria in Solid Tumors （RECIST, version 1.1 ）, including complete response （CR）, partial response （PR）, stable disease （SD） and progressive disease （PD）. The overall response rate （ORR） was counted with the total number of patients divided by the number of CR ＋PR. Differences in first-line and second-line chemotherapy efficacy among different primary tumor sites in metastatic colorectal cancer were compared by using Chi-square test. Results Of the 571 patients receiving first-line chemotherapy, no one patient was classified as CR, while there were 190 as PR （33.3%）, 277 as SD （48.5%） and 104 as PD （18.2%）, with ORR 33.3% （190/571）. The ORRs of patients with primary tumor located at ileocecum, ascending colon or hepatic flexure, transverse colon or splenic flexure, descending or sigmoid colon, rectum were 21.3% （10/47）, 35.3% （36/102）, 14.3% （3/21）, 41.3% （57/138）and31.9% （84/263）, respectively, with statistically significant difference（P = 0.028）. Difference of oxaliplatin-based first-line chemotherapy efficacy among different tumor sites was statistically significant （P = 0.009）, while differences in irinotecan-based or single-agent 5-fluorouracil chemotherapy efficacy were not statistically significa

关 键 词：结直肠肿瘤 转移性 原发部位 化疗 疗效 

分 类 号：R735.34[医药卫生—肿瘤]