直肠癌新辅助放化疗后cCR患者不同治疗方法随访观察  

Follow-up observation of rectal cancer patients with clinical complete response receiving non- operative and standard operative management after neo-adjuvant chemoradiotherapy

作　　者：张术 魏嘉旺 肖巍魏[1] 王俏镟[1] 常晖[1] 曾智帆[1] 丁培荣[2] 陈功[2] 潘志忠[2] 高远红[1] Department of Radiation Oncology(Zhang S, Wei JW,Xiao WW, Wang QX, Chang H,Zeng ZF, Gao YH） , Department of Colorectal Surgery （ Ding PR, Chen G, Pan ZZ ） , Sun Yat-sen University Cancer Center, State Key laboratory of Oncology in South China, Guangzhou 510060, Chin)

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疗科,广州510060 [2]华南肿瘤学国家重点实验室、中山大学结直肠科,广州510060

出　　处：《中华放射肿瘤学杂志》2018年第4期374-377,共4页Chinese Journal of Radiation Oncology

摘　　要：目的 通过比较新辅助放化疗后cCR的直肠癌患者采用非手术治疗和TME治疗的效果,旨在探讨非手术治疗策略的可行性。方法 选取2006—2016年中山大学肿瘤防治中心接受术前放化疗并获得cCR的135例Ⅱ、Ⅲ期直肠癌患者,根据治疗方法的不同将其分为非手术组（43例NOM组）和标准手术组（92例SOM组）。比较2组患者的局部复发率、挽救性治疗后的累计LC率、DFS、OS以及保肛率等。Kaplan-Meier法计算LC、OS、DFS并Logrank法检验,χ2检验保肛率。结果 中位随访39个月（10~127个月）。135例患者的局部复发率及远处转移率分别为3.7%和11.1%,术后3年DFS和OS分别为90.5%和97.0%。NOM组与SOM组术后3、5年DFS率分别为87%与93%、73%与87%（P=0.089）,OS率分别为98%与99%、98%与97%（P=0.578）。NOM组局部复发5例（12%）,80%患者得到挽救性治疗,累计LC率为98%;SOM组无局部复发病例;两组差异有统计学意义（P=0.010）。NOM组保肛率为93%,显著高于SOM组的70%（P=0.030）。结论 新辅助放化疗后获得cCR的直肠癌患者采取非手术治疗策略是可行的,部分局部复发患者仍可通过及时的挽救性治疗痊愈,从而有效避免了TME及其并发症,提高了患者的生活质量。Objective To investigate the feasibility of non-operative management （NOM） by comparing the therapeutic effects between NOM and total mesorectal excision （TME） for rectal cancer patients with clinical complete response （cCR） after neo-adjuvant chemoradiotherapy. Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM （n=43） and standard operative management （SOM） groups （n=92）. The local recurrence rate,accumulative local control （LC） rate after salvage therapy,disease-free survival （DFS）,overall survival （OS） and sphincter preservation rate were statistically compared between two groups. Kaplan-Meier analysis and log-rank test were utilized to calculate the LC, OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate. Results The mean follow-up duration was 39 months （range：10-127 months）.Of 135 patients, the local recurrence rate and distant metastasis rate were 3.7% and 11.1%,and the 3-year DFS and OS were 90.5% and 97.0%.In the NOM and SOM groups, the 3-year DFS were 87% and 93%, and the 5-year DFS were 73% and 87%（P=0.089）.The 3-year OS were 98% and 99%, and the 5-year OS were 98% and 97%（P=0.578）.In the NOM group, the local recurrence rate was 12%（n=5）,80% of patients received salvage treatment and the accumulative LC rate was calculated as 98%.In the SOM group, the local recurrence rate was 0, which was significantly lower than that in the NOM group （P=0.010）.In the NOM group, the sphincter preservation rate was 93%, significantly higher compared with 70% in the SOM group （P=0.030）. Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy. Partial locally recurrent patients can be healed by timely salvage therapy,thereby averting TME and relevant complications and enhancing the quality of life of

关 键 词：直肠肿瘤 新辅助放化疗 临床完全缓解 随访观察 

分 类 号：R735.37[医药卫生—肿瘤]