转为可切除同时性肝转移结肠癌患者的肿瘤退缩分级与影像学评估的一致性观察  

Clinical observation of TRG and imaging findings after neoadjuvant chemotherapy for resectable patients initially considered as unresectable colorectal cancer with liver metastases

作　　者：潘军 秦叔逵[1] 陈映霞[1] 黄勇 杨志慧 PAN Jun;QIN Shukui;CHEN Yingxia;HUANG Yong;YANG Zhihui(Department of Medical Oncology,Cancer Center of PLA,81 Hospital Affiliated to Nanjing University of Chinese Medicine,Nanjing 210002,China)

机构地区：[1]南京中医药大学附属八一医院全军肿瘤中心肿瘤内科,南京210002 [2]南京中医药大学附属八一医院病理科,210002

出　　处：《临床肿瘤学杂志》2018年第6期553-558,共6页Chinese Clinical Oncology

摘　　要：目的观察初始不可切除的同时性肝转移结肠癌患者经新辅助化疗后转化为可切除者的肿瘤退缩分级(TRG分级)和影像学表现的一致性。方法回顾分析本院2012年1月至2017年6月收治的初始不可切除的26例同时性肝转移晚期结肠癌患者的临床资料,其中6例经新辅助化疗后转化为可切除者。分别应用RECIST 1.1版与NCI-CTC 4.0版标准评价疗效和不良反应。应用AJCC-TRG分级标准进行TRG分级,Spearman等级相关分析影像学退缩和TRG分级的相关性,Kaplan-Meier法进行生存分析。结果 6例患者均可评价疗效和不良反应,共完成42个周期的新辅助化疗,中位化疗6个周期(3~14个周期)。共获PR 3例、SD 3例。1例患者的TRG分级为2分,5例患者的TRG分级均为3分。6例患者的影像学肿瘤退缩和TRG分级之间无相关性(r=0.131,P=0.805)。常见不良反应多为1~2级,主要为白细胞减少、中性粒细胞减少、乏力及恶心等。全组的总生存期为10.0~27.4个月,中位总生存期为25.5个月。结论初始不可切除的同时性肝转移结肠癌患者新辅助化疗后转化为可切除者的TRG分级和影像学表现间具有较大的不一致性,可能与其分期、是否联合放疗和病理检测技术有关。Objective To observe the relationship between tumor regression grade(TRG)and imaging findings after neoadjuvant chemotherapy for resectable patients who were initially considered as unresectable colorectal cancer with liver metastases.Methods From January 2012 to June 2017,the clinical data of 26 patients with advanced liver cancer who were initially resectablewere retrospectively analyzed and 6 of them were converted to resectable patients after neoadjuvant chemotherapy.The efficacy and safety were evaluated by RECIST 1.1 and NCI-CTC 4.0 criteria,respectively.An AJCC-TRG grading criterion was used for TRG.Correlation analysis between radiographic regression and TRG was performed by using Spearman grade correlation analysis.The Kaplan-Meier method was used for survival analysis.Results The efficacy and adverse reactions were evaluated in 6 patients.The total treatment cycle of chemotherapy of 6 patients was 42,and the median treatment cycle was 6(3-14 cycles).Three cases of PR and 3 cases of SD were observed.One case of TRG 2 and 5 cases of TRG 3 were observed.There was no correlation between TRG and imaging findings(r=0.131,P=0.805).The major treatment-related side effects including leucopenia,neutropenia,nausea,vomiting,fatigue and etc,were mainly in grade 1-2.The overall survival was 10.0-27.4 months with a median overall survival of 25.5 months.Conclusion There was inconsistency in TRG and imaging findings after neoadjuvant chemotherapy for resectable patients initially considered as unresectable colorectal cancer with liver metastases.The inconsistency was related to TNM stage,radiotherapy and pathology technique.

关 键 词：结肠癌 肝转移 肿瘤退缩分级 初始不可切除 新辅助化疗 

分 类 号：R735.3[医药卫生—肿瘤]