不同化疗方案对接受根治性放化疗的非转移性肛管鳞癌患者放射性肠损伤发生的影响  

Effects of radical radiotherapy combined with different regimens of chemotherapy on radiation intestinal injury in patients with non-metastatic anal squamous cell carcinoma

作　　者：庞晓琳[1] 刘帅 刘艳平[1] 陈海洋 何妨[1] 郑坚[1] 万香波 Pang Xiaolin;Liu Shuai;Liu Yanping;Chen Haiyang;He Fang;Zheng Jian;Wan Xiangbo(Department of Radiotherapy,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院放射治疗科广东省结直肠盆底疾病研究重点实验室,广州510655

出　　处：《中华胃肠外科杂志》2021年第11期977-983,共7页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的探讨根治性放疗联合不同的化疗方案[含氟尿嘧啶(5-FU)方案对比多西紫杉醇联合顺铂(TP)方案]对非转移性肛管鳞癌患者放射性肠损伤的发生情况及预后的影响。方法采用回顾性队列研究方法,收集2013年7月至2021年1月期间于中山大学附属第六医院及南方医科大学南方医院行根治性放化疗的非转移性肛管鳞癌患者的临床资料。纳入标准:(1)初治的肛管及肛周鳞癌;(2)已完成根治性放疗或放化疗;(3)放疗前肿瘤可评估。排除标准:(1)治疗前无影像评估,无法确定肿瘤分期;(2)患者在放(化)疗前已行局部或根治性切除;(3)治疗前或放化疗期间发生远处转移;(4)复发肛管鳞癌。共纳入患者55例(中山大学附属第六医院48例,南方医科大学南方医院7例),根据放疗同步联合化疗方案的不同,分为5-FU化疗组(34例)和TP化疗组(21例)。比较两组放射性肠损伤评估情况、血液学毒性和3年无病生存率(DFS),分析化疗方案及其他临床病理因素对患者急慢性放射性肠损伤发生率及严重程度的影响,放射性肠损伤的评估采用美国肿瘤放射治疗协作组(RTOG)标准。结果放疗期间及放疗结束后3个月内,共有45例患者出现急性放射性肠损伤,1级18例(32.7%),2级22例(40.0%),3级5例(9.1%);无患者发生慢性放射性肠损伤。34例5-FU化疗组的患者中,21例(61.8%)发生2~3级放射性肠损伤反应,高于TP化疗组(6/21,28.6%),差异有统计学意义(χ^(2)=5.723,P=0.017)。多因素分析显示,5-FU化疗是放射性肠损伤的独立危险因素(HR=4.038,95%CI:1.250~13.045,P=0.020)。中位随访26(5~94)个月,TP化疗组及5-FU化疗组患者3年无病生存率(DFS)分别为66.8%和77.9%,差异无统计学意义(P=0.478)。单因素分析显示,本组患者DFS与性别、年龄、肿瘤位置、T分期、N分期及有无诱导化疗有关(均P<0.05);多因素分析显示,年龄≥50岁是患者预后不良的独立危险因素(HR=8.301,95%CI:1.130~60.Objective To investigate the effects of radical radiotherapy combined with different chemotherapy regimens(fluorouracil-based versus docetaxel plus cisplatin)on the incidence of radiation intestinal injury and the prognosis in patients with non-metastatic anal squamous cell carcinoma.Methods A retrospective cohort study was conducted to recruit non-metastatic anal squamous cell carcinoma patients who underwent chemoradiotherapy in the Sixth Affiliated Hospital of Sun Yat-sen University and Nanfang Hospital from July 2013 to January 2021.Inclusion criteria:(1)newly diagnosed anal and perianal squamous cell carcinoma;(2)completed radical radiotherapy combined with concurrent chemotherapy;(3)tumor could be evaluated before radiotherapy.Exclusion criteria:(1)no imaging evaluation before treatment,or the tumor stage could not be determined;(2)patients undergoing local or radical resection before radiotherapy;(3)distant metastasis occurred before or during treatment;(4)recurrent anal squamous cell carcinoma.A total of 55 patients(48 from the Sixth Affiliated Hospital of Sun Yat-sen University and 7 from Nanfang Hospital)were given fluorouracil(the 5-FU group,n=34)or docetaxel combined with the cisplatin(the TP group,n=21).The evaluation of radiation intestinal injury,hematological toxicity and 3-year disease-free survival(DFS)rate were compared between the two groups.The effects of chemotherapy regimen and other clinicopathological factors on the incidence and severity of acute and chronic radiation intestinal injury were analyzed.The assessment of radiation intestinal injury was based on the American Cancer Radiotherapy Cooperation Group(RTOG)criteria.Results During radiotherapy and within 3 months after radiotherapy,a total of 45 patients developed acute radiation intestinal injury,including 18 cases of grade 1(32.7%),22 cases of grade 2(40.0%)and 5 cases of grade 3(9.1%).No patient developed chronic radiation intestinal injury.Among the 34 patients in the 5-FU group,21 had grade 2-3 radiation intestinal injury(21/34

关 键 词：肛管鳞癌 非转移性 放化疗 放射性肠损伤 预后分析 

分 类 号：R735.38[医药卫生—肿瘤]