肿瘤体积对局部进展期直肠癌预后的影响  

The effect of tumor volume on the prognosis of locally advanced rectal cancer

作　　者：邹伟静 邹敏 吴峥 朱苏雨 席珍 刘科 袁媛 汪洁 周菊梅 Weijing Zou;Min Zou;Zheng Wu;Suyu Zhu;Zhen Xi;Ke Liu;Yuan Yuan;Jie Wang;Jumei Zhou(Department of Radiation Oncology,Abdominal Section,The Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University(Hunan Cancer Hospital),Changsha 410013,China)

机构地区：[1]中南大学湘雅医学院附属肿瘤医院(湖南省肿瘤医院)腹部放疗科,长沙市410013

出　　处：《中国肿瘤临床》2020年第12期626-632,共7页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨肿瘤体积(gross tumor volume,GTV)对接受新辅助放化疗(neoadjuvant chemoradiotherapy,NCRT)和全直肠系膜切除术(total mesorectal excision,TME)后,局部进展期直肠癌(locally advanced rectal cancer,LARC)患者的预后影响。方法:回顾性分析2011年1月至2016年9月湖南省肿瘤医院收治的128例初治直肠癌患者的临床资料,均接受术前同步放化疗+TME。采用受试者工作特征曲线(receiver-operating characteristic,ROC)分析GTV截点值,用Kaplan-Meier生存分析和Cox比例风险回归模型进行预后分析。结果:行NCRT后T分期降期率为58.6%,N分期降期率为69.5%,总体降期率为77.3%,病理完全缓解(pathologi-cal complete response,p CR)率为16.4%,总体保肛率为57.03%。GTV的截点为79.31 m L,GTV≥79.31 m L与GTV<79.31 m L患者的3年总生存率(overall survival,OS)、无病生存率(disease-free survival,DFS)、无局部复发生存率(local relapse free survival,LRFS)、无远处转移生存率(distant-metastasis-free survival,DMFS)有显著性差异。GTV与MRI-T分期(ρ=0.236,P=0.007)、T分期变化(ρ=0.229,P=0.009)、TNM分期变化(ρ=0.219,P=0.013)及肿瘤退缩分级(tumor regression grade,TRG)(ρ=0.517,P<0.001)相关,与MRI-T分期、MRI-N分期及N分期变化无关。结论:GTV与LARC的局部复发、远处转移密切相关,是预后因素之一;肿瘤体积与治疗前T分期、新辅助治疗后的T分期变化、TNM分期变化及TRG相关,与治疗前N分期及N分期变化无关。Objective:To evaluated the prognostic effect of tumor volume in patients with locally advanced rectal cancer(LARC)treated with neoadjuvant chemoradiotherapy(NCRT)and total mesorectal excision(TME).Methods:This was a retrospective analysis of 128 patients with newly diagnosed rectal cancer who received preoperative concurrent chemoradiation plus TME from January 2011 to September 2016 in Hunan Cancer Hospital.The receiver-operating characteristic(ROC)curve was used to analyze the gross tumor volume(GTV)cut-off point.Prognostic analysis was performed using Kaplan-Meier,Log-rank,and Cox regression models.Results:After NCRT,T-stage declined 58.6%,N-stage declined 69.5%,and the overall TNM stage declined 77.3%.After NCRT,the pathological complete response(pCR)rate was 16.4%and the anus-protection rate was 57.03%.The GTV cut-off point was 79.31 mL.There were significant differences in OS,DFS,LRFS and DMFS between patients with GTV≥79.31 mL and patients with GTV<79.31 mL over three years.GTV was significantly related to MRI-T staging(ρ=0.236;P=0.007),T downstaging(ρ=0.229;P=0.009),TNM downstaging(ρ=0.219;P=0.013),and tumor regression grade(TRG)(ρ=0.517;P<0.001);however,GTV was not significantly related to MRI-N staging and N downstaging.Conclusions:GTV is closely related to local recurrence and distant metastasis of LARC,and is an important prognostic factor.Tumor volume was significantly related to pretreatment MRI-T staging,T downstaging,TNM downstaging after NCRT,and TRG,but not to pretreatment MRI-N staging and N downstaging.

关 键 词：新辅助放化疗 局部进展期直肠癌 肿瘤体积 肿瘤降期 预后 

分 类 号：R735.37[医药卫生—肿瘤]