侧方淋巴结转移对进展期直肠癌新辅助放化疗联合手术疗效的影响  

Effect of lateral lymph node metastasis on the efficacy of neoadjuvant chemoradiotherapy combined with surgery for advanced rectal cancer

作　　者：阿曼姑丽·艾合买提 王海峰[1] 陆艳荣[1] 张鑫 AMANGULI·Aihemaiti;WANG Haifeng;LU Yanrong;ZHANG Xin(Department of Radiotherapy of the Chest and Abdomen,Affiliated Cancer Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院胸腹放射治疗科,乌鲁木齐830011

出　　处：《重庆医学》2021年第18期3140-3145,共6页Chongqing medicine

基　　金：新疆维吾尔自治区自然科学基金资助项目(2016D01C361)。

摘　　要：目的评估新辅助放化疗对伴有侧方淋巴结转移的进展期直肠癌患者的临床疗效,研究侧方淋巴结转移等相关临床因素对进展期直肠癌远期生存的影响。方法回顾性分析该院2010-2015年收治的78例局部进展期直肠癌患者的临床资料,所有患者完成了术前调强放疗(45.0~50.6 Gy),同步采用奥沙利铂+卡培他滨/氟尿嘧啶或单药卡培他滨化疗,于新辅助治疗后6~12周行全直肠系膜切除。将纳入的患者依据初诊时有无侧方淋巴结转移分为侧方淋巴结转移阳性组(29例)与阴性组(49例),比较两组病理完全缓解率(pCR)、5年侧方型复发率、无进展生存(PFS)率及总生存(OS)率。Kaplan-Meier法绘制生存曲线,Cox回归行影响生存的多因素分析。结果78例患者中男55例,女23例;年龄29~75岁,中位56岁;临床T3期者20例(25.6%),T4期者58例(74.4%),临床N1期者50例(64.1%),N2期者28例(35.9%);肿瘤长径小于4.0 cm者41例,≥4 cm者37例;初始血清癌胚抗原(CEA)水平正常者45例,异常者33例;全组达pCR者8例(10.3%);共70例接受了术后辅助化疗(89.7%)。全组侧方淋巴结阳性29例(37.2%),低分化癌、癌灶长径大于或等于4.0 cm和浸润性癌患者的侧方淋巴结转移率较高(P<0.05)。全组78例均获得随访,中位随访60.5个月。侧方阳性组常规剂量新辅助放化疗后5年侧方型复发率明显高于侧方阴性组(13.8%vs.4.2%,P<0.05);而阳性组中,新辅助放化疗后侧方淋巴结明显缩小或消失(<5 mm)的患者,其5年内侧方型复发率仍达16.7%(3/18)。侧方淋巴结阳性组的5年PFS率和OS率分别为44.8%、46.4%,明显低于阴性组的63.3%和64.6%,差异有统计学意义(P<0.05)。影响生存的多因素分析结果显示,患者年龄、肿瘤的大体分型、疗前血清CEA值、cN分期和侧方淋巴结转移是进展期直肠癌预后的影响因素(P<0.05)。结论伴有侧方转移的进展期直肠癌,即使对新辅助放化疗有反应,仍有一定的侧方型复发�Objective To evaluate the clinical efficacy of neoadjuvant chemoradiotherapy in patients with advanced rectal cancer with lateral lymph node metastasis,and to investigate the prognostic factors of advanced rectal cancer.Methods Clinical data of 78 patients with locally advanced rectal cancer admitted to hospital from 2010 to 2015 were retrospectively analyzed.All the patients had been completed preoperative intensity-modulated radiotherapy 45.0—50.6 Gy,synchronized with oxaliplatin+capecitabine/fluorouracil or single drug capecitabine chemotherapy,and total mesorectal excision was performed 6—12 weeks after neoadjuvant therapy.The included patients were divided into the positive group(29 cases)and the negative group(49 cases)based on whether there was lateral lymph node metastasis at the first diagnosis.The pathological complete response rate(pCR),recurrence characteristics and the 5-year overall survival(OS)and progression-free survival(PFS)were compared between the two groups,the Kaplan-Meier method was used for survival analysis,and Cox′s regression model for multivariate analysis.Results There were 55 males and 23 females,the median age was 56 years with 29-75 years old;clinical T320 cases,clinical T458 cases,clinical N150 cases,clinical N228 cases,tumor size<4.0 cm in 41 cases and≥4.0 cm in 37 cases,normal carcino-embryonic antigen(CEA)level in 45 cases and abnormal in 33 cases.The pCR rate was 10.3%.The median follow-up time was 60.5 month.Lateral lymph node metastasis occurred in 29 patients(37.2%),poorly differentiated cancer,tumor size and invasive cancer were risk factors for lateral lymph node metastasis in advanced rectal cancer(P<0.05).The lateral recurrence rate in the positive group was significantly higher than that in the negative group(13.8%vs.4.2%,P<0.05).The patients that lateral lymph nodes were significantly reduced(<5 mm)or disappeared after neoadjuvant therapy in the positive group,still had a recurrence rate of 16.7%(3/18)within 5 years.The 5-year OS and PFS rates of the positive

关 键 词：直肠恶性肿瘤 局部进展期直肠癌 新辅助放化疗 全直肠系膜切除术 侧方淋巴结转移 侧方淋巴结清扫术 

分 类 号：R735.37[医药卫生—肿瘤]