新辅助治疗联合经内外括约肌间切除术治疗低位/超低位直肠癌的长期效果  

Long-term outcomes of neoadjuvant therapy combined with intersphincteric resection for low/ultra-low rectal cancer

作　　者：涂升金 张雯迪 刘健博 殷晋 汪晓东[1] 李立[5] 杨烈[1,6] TU Shengjin;ZHANG Wendi;LIU Jianbo;YIN Jin;WANG Xiaodong;LI Li;YANG Lie(Division of Gastrointestinal Surgery,Department of General Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Department of General Surgery,Fourth People’s Hospital of Zigong,Zigong,Sichuan 643000,P.R.China;West China Clinical Medical College of Sichuan University,Chengdu 610041,P.R.China;Institute of Biomedical Big Data,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Colorectal Cancer Center,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;Institute of Digestive Surgery,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院普外科胃肠外科病房,成都610041 [2]自贡市第四人民医院普外科,四川自贡643000 [3]四川大学华西临床医学院,成都610041 [4]四川大学华西医院生物医学大数据研究院,成都610041 [5]四川大学华西医院结直肠肿瘤中心,成都610041 [6]四川大学华西医院普外科研究所,成都610041

出　　处：《中国普外基础与临床杂志》2024年第5期538-546,共9页Chinese Journal of Bases and Clinics In General Surgery

基　　金：四川省自然科学基金面上项目(项目编号:2022NSFSC0840);四川省科技厅重点研发计划(项目编号:24SYSX0206)。

摘　　要：目的基于当前最新版本华西肠癌数据库(Database from Colorectal Cancer,DACCA)分析直肠癌患者采用新辅助治疗联合经内外括约肌间切除术(intersphincteric resection,ISR)的长期效果。方法根据制定的筛选条件,从2024年3月21日更新的DACCA中收集2009年1月至2020年12月期间收治的944例直肠癌患者的临床资料,采用Cox比例风险回归分析探索总生存期(overall survival,OS)和特异性疾病生存期(disease specific survival,DSS)的影响因素。结果①新辅助治疗联合ISR治疗直肠癌的3年OS和DSS率分别为89.2%和90.4%,5年OS和DSS率分别为83.9%和85.4%。②不同ISR术式组、单纯化疗与放化疗组患者的总体、3年及5年OS和DSS比较差异均无统计学意义(P>0.05);不同ypTNM分期组患者的总体、3年、5年OS和DSS比较差异均存在统计学意义(P<0.001),0~Ⅱ期者较优。③BMI、ypTNM分期和R0切除均是OS和DSS的影响因素(P<0.05)。④患者术后总体并发症发生率较低,其中术后30d以内发生率为6.4%(60/944),术后30d至半年内发生率为7.5%(71/944),半年以上发生率为3.3%(31/944)。结论在低位/超低位直肠癌患者的综合治疗中,采用新辅助治疗联合ISR手术可获得较为稳定、良好的远期肿瘤学疗效,且术后近期并发症的发生率不高,是可以选择的手段之一。Objective Based on the latest version of the Database from Colorectal Cancer(DACCA),this study analyzed the long-term effect of neoadjuvant therapy combined with intersphincteric resection(ISR)in patients with rectal cancer.Methods According to the established screening criteria,clinical data of 944 patients with rectal cancer admitted from January 2009 to December 2020 were collected from the DACCA updated on March 21,2022,to explore the influencing factors for overall survival(OS)and disease specific survival(DSS)of rectal cancer treated with neoadjuvant therapy combined with ISR,by Cox proportional hazard regression model.Results①The 3-year OS and DSS survival rates of neoadjuvant therapy combined with ISR for rectal cancer were 89.2%and 90.4%,respectively,and the 5-year OS and DSS survival rates were 83.9%and 85.4%,respectively.②For different ISR surgical methods and neoadjuvant therapy plans,there were no significant differences in OS and DSS(P>0.05),but there were significant differences in OS and DSS among different ypTNM stage groups(P<0.001),patients with ypTNM 0–Ⅱhad better OS and DSS.③BMI,ypTNM stage and R0 resection were influencing factors for OS and DSS(P<0.05).④The overall incidence of postoperative complications was low,including 6.4%(60/944)within 30 days,7.5%(71/944)within half a year and 3.3%(31/944)over half a year after operation.Conclusions In the comprehensive treatment of patients with low/ultra-low rectal cancer,neoadjuvant therapy combined with ISR can achieve relatively stable and good long-term oncological efficacy,and the incidence of short-term postoperative complications is not high,which is one of the options.

关 键 词：直肠癌 新辅助治疗 经内外括约肌间切除术 长期效果 并发症 保肛 

分 类 号：R73[医药卫生—肿瘤]