中低位局部进展期直肠癌行新辅助放化疗后临床完全缓解患者采取等待观察策略的预后及影响因素分析  

Prognosis and influencing factors analysis of watch⁃and⁃wait strategy in patients with complete clinical response after neoadjuvant chemoradiotherapy for middle⁃low locally advanced rectal cancer

作　　者：高树全[1] 武雪亮[1,2] 薛军[1,2] 屈明[1] 郭飞[1] 费建东[1] 张迎春[1] 马洪庆 GAO Shuquan;WU Xueliang;XUE Jun;QU Ming;GUO Fei;FEI Jiandong;ZHANG Yingchun;MA Hongqing(Department of General Surgery,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;不详)

机构地区：[1]河北北方学院附属第一医院普通外科,河北张家口075000 [2]河北北方学院附属第一医院肿瘤研究所,河北张家口075000 [3]河北医科大学第四医院外二科,石家庄050000

出　　处：《实用医学杂志》2022年第21期2691-2696,共6页The Journal of Practical Medicine

基　　金：河北省高层次人才资助项目(编号:A202101062);河北省财政厅临床医学优秀人才培养项目(编号:361009)。

摘　　要：目的探讨中低位局部进展期直肠癌行新辅助放化疗后临床完全缓解直肠癌患者采取等待观察(wait&watch,W&W)策略的预后及影响因素分析。方法回顾性纳入2015年1月至2019年12月在河北北方学院附属第一医院普通外科和河北医科大学第四医院外二科行新辅助放化疗后临床完全缓解中低位局部进展期直肠癌患者,比较采取W&W策略(23例)与全直肠系膜切除术(TME)(30例)患者的预后情况,采用单因素和多因素Cox比例风险回归模型分析W&W患者无病生存期和总体生存的影响因素。结果中位随访时间为36个月,W&W患者与TME患者的中位无病生存期、中位总生存期、3年无病生存率、3年总生存率及复发率分别为32.6个月、35.7个月、80.43%、89.13%,19.57%与35.1个月、38.4个月、83.33%、93.33%、16.67%,差异无统计学意义(P>0.05);单因素分析显示,肿瘤下缘距肛缘距离≤4 cm、淋巴转移阳性W&W患者的无病生存期明显缩短,差异有统计学意义,P<0.05;淋巴转移阳性W&W患者的总生存期明显缩短,差异有统计学意义(P<0.05);多因素分析显示,肿瘤下缘距肛缘距离≤4 cm(HR=16.371,95%CI:3.2369~134.542,(P=0.003)、淋巴转移阳性(HR=5.863,95%CI:1.127~12.334,P=0.006)是W&W患者无病生存期缩短的独立危险因素,淋巴转移阳性(HR=4.602,95%CI:1.053~15.772,P=0.038)是W&W患者总生存期缩短的独立危险因素。结论新辅助放化疗后临床完全缓解直肠癌患者采取W&W策略与TME的预后无明显差异,肿瘤下缘距肛缘距离及淋巴转移状态是W&W患者预后的影响因素。Objective To discuss prognosis and influencing factors of watch⁃and⁃wait(W&W)strategy in patients who had a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer.Methods The patients with clinical complete response after neo⁃adjuvant chemoradiotherapy for locally advanced rectal cancer who were enrolled in our hospital retrospectively between January 2015 and December 2019.The prognosis of patients with W&W strategy(46 cases)and total mesorectal excision(TME)(60 cases)were compared.The univariate and multivariate Cox proportional risk regression models were used to analyze the influencing factors of disease⁃free survival and overall survival in W&W patients.Results The median follow⁃up period was 36 months.The median disease⁃free survival,median overall survival,3⁃year disease⁃free survival,3⁃year overall survival and recurrence rates of W&W patients and TME patients were 32.6 months,35.7 months,80.43%,89.13%,19.57%and 35.1 months,38.4 months,83.33%,93.33%,16.67%,respectively,with no statistically significant differ⁃ence(P>0.05).The univariate analysis showed that the disease⁃free survival was significantly shortened in W&W patients with tumor lower margin to anal margin distance≤4 cm and positive lymph node metastasis(P<0.05),the overall survival was significantly shortened in W&W patients with positive lymph node metastasis(P<0.05).The multivariate analysis showed that the tumor lower margin to anal margin distance>≤4 cm(HR=16.371,95%CI:3.2369~134.542,P=0.003)and positive lymph node metastasis(HR=5.863,95%CI:1.127~12.334,P=0.006)were found to be the independent risk factors for shortened disease⁃free survival of W&W patients.The positive lymph node metastasis(HR=4.602,95%CI:1.053~15.772,P=0.038)was the independent risk factors for shortened overall survival of W&W patients.Conclusion After neoadjuvant chemoradiotherapy for rectal cancer,there was no significant difference in prognosis between patients who used the W&W strategy and those who used TME.The tum

关 键 词：局部进展期直肠癌 新辅助放化疗 临床完全缓解 等待观察 预后 影响因素 

分 类 号：R735.3[医药卫生—肿瘤]