不同TNM分期直肠癌辅助化疗预后分析  

Prognostic analysis of adjuvant chemotherapy in different TNM stages of rectal cancer

作　　者：李振生[1] 李月 郝凯凯 段学娟 韩慧娜 张钧[1] LI Zhen-sheng;LI Yue;HAO Kai-kai;DUAN Xue-juan;HAN Hui-na;ZHANG Jun(Department of Radiation Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang050035,P.R.China)

机构地区：[1]河北医科大学第四医院放疗科,河北石家庄050035

出　　处：《中华肿瘤防治杂志》2020年第23期1919-1926,共8页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的评估直肠癌根治术后辅助化疗(adjuvant chemotherapy,aCT)在不同病理分期患者间与总体生存(overall survival,OS)和无疾病进展生存(progression free survival,PFS)关系。方法收集河北医科大学第四医院2010-01-01-2011-12-31无新辅助治疗直肠癌根治术患者570例,随访至2017-12-01。应用多因素Cox生存模型评估aCT影响OS和PFS的风险比(HR)和P值。入组患者平均年龄59岁,女239例(41.9%),行Dixon术者388例(68.1%),行Miles术者173例(30.4%),腺癌505例(88.6%),pT3-4期421例(73.8%),pN1-2期228例(40.0%),术后放疗62例(10.9%),辅助化疗288例(50.5%)。结果随访结果显示,所有患者5年粗死亡率为26.1%,治疗失败(死亡/复发/转移)率为32.7%。辅助化疗多因素调节计算HR值,总体OS为0.748(P=0.093),PFS为0.876(P=0.408);pT3-4期OS为0.670(P=0.025),PFS为0.802(P=0.181);pN1-2期OS为0.686(P=0.084),PFS为0.212,P=0.771;pT3-4N1-2期OS为0.649(P=0.045),PFS为0.753,P=0.185。结论aCT对生存的影响在pT、pN分组和其交叉分组患者间有差异,aCT能明显提高pT3-4N1-2患者OS,但对PFS影响不明确。OBJECTIVE To evaluate overall survival(OS)and progression-free survival(PFS)differences improved by adjuvant chemotherapy(aCT)after radical surgery among pathological subgroups of rectal cancer patients(pts).METHODS A total of 570pts admitted at the Fourth Hospital of Hebei Medical University in 2010-2011without neoadjuvant therapy were collected and followed up till December 1,2017.Multivariable Cox models evaluated the hazard ratio(HR)and Pvalue of aCT on improving OS and PFS.They had age mean 59years old,female 239(pts,41.9%),surgery in Dixon 388(68.1%)and Miles 173(30.4%),adenocarcinoma 505(88.6%),pT3-4421(73.8%),pN1-2228(47.0%),RT 62(10.9%),aCT 288(50.5%).RESULTS The crude 5-year mortality(26.1%)and treatment failure(death,recurrence,metastasis)rate(32.7%)were estimated by K-M curves.The adjusted HR(P)values of aCT were:OS 0.748(P=0.093)&PFS 0.876(P=0.408)for the entire cohort;OS 0.670(P=0.025)&PFS 0.802(P=0.181)for pT3-4subgroup;OS 0.686(P=0.084)&PFS 0.212(P=0.771)for pN1-2;OS 0.649(P=0.045)&PFS 0.753(P=0.185)for pT3-4N1-2.CONCLUSIONS aCT has different survival effects among subgroup pts classified by pT or/and pN,and significantly improves OS for pT3-4N1-2pts.However,its effect on improving PFS is not yet established.

关 键 词：直肠癌根治术 辅助化疗 总体生存 无疾病进展生存 

分 类 号：R735.3[医药卫生—肿瘤]