中低位进展期直肠癌新辅助治疗后病理完全缓解5例并文献复习  

Pathologic complete response after neoadjuvant therapy of middle and low advanced rectal cancer: 5 case reports and literature review

作　　者：汤博华 陈会永 姚秋艳 Tang Bohua;Chen Huiyong;Yao Qiuyan(Third Department of General Surgery,People's Hospital of Dali Bai Autonomous Prefecture,Dali 671000,China;Department of Gastroenterology,First Affiliated Hospital of Dali University,Dali 671000,China)

机构地区：[1]大理白族自治州人民医院普外三科,大理671000 [2]大理大学第一附属医院消化内科,大理671000

出　　处：《中华转移性肿瘤杂志》2024年第4期371-375,共5页Chinese Journal of Metastatic Cancer

摘　　要：目的分析术前新辅助治疗在中低位进展期直肠癌治疗中的作用。方法收集大理白族自治州人民医院2020—2023年间收治的进展期中低位直肠癌患者行术前新辅助治疗+直肠全系膜切除术后病理学完全缓解(pCR)病例5例。根据临床表现、体格检查、实验室检查、影像学检查、治疗方案及病理结果对其进行总结并文献复习。结果5例患者年龄为51~65岁,平均年龄58岁;3例为女性,2例为男性;T分期为T_(2)-T_(3),N分期为N_(0)-N_(1)、N+,均无远处转移。3例给予术前诱导化疗+长程同步放化疗+巩固化疗,2例给予单纯新辅助化疗;治疗后结合MRI及肠镜检查,均实现明显肿瘤降期;2例结合肠镜检查达到临床完全缓解,均行直肠全系膜切除术;术后病理检查提示肿瘤退缩分级0级(AJCC第8版),均达到pCR。随访10~40个月无复发。结论中低位进展期直肠癌患者,特别是保肛欲望强烈但又保肛困难的患者,应积极行术前新辅助治疗,部分患者可达pCR,结合直肠全系膜切除术可提高保肛率及获得更高的总生存期。ObjectiveThis study aims to analyze the effect of preoperative neoadjuvant therapy on the treatment of middle and low advanced rectal cancer.MethodsA total of 5 cases of pathological complete remission of middle and low advanced rectal cancer after preoperative neoadjuvant therapy+total mesorectal excision were collected from 2020 to 2023 in Dali People's Hospital.All cases were summarized according to clinical manifestations,physical examination,laboratory examination,imaging examination,treatment regimen and pathological results,and relevant literature was reviewed.ResultsThe 5 patients was aged from 51 to 65 years old with an average age of 58 years old,among which 3 patients were female and 2 patients were male.The T stage included T_(2)-T_(3),and the N stage included N_(0)-N_(1),N+,without distant metastasis.3 patients received preoperative induction chemotherapy+long-term concurrent chemoradiotherapy+consolidation chemotherapy,and 2 patients received simple neoadjuvant chemotherapy.Combined with MRI and colonoscopy after treatment,all patients achieved significant tumor regression stage.2 patients underwent total mesorectal excision and achieved clinical complete response combined with colonoscopy.Postoperative pathological examination indicated pathological complete response in all cases.Follow-up for 10-40 months showed no recurrence.ConclusionsThe patients with middle and low advanced rectal cancer,especially those with strong desire for anal preservation,should be actively treated with preoperative neoadjuvant therapy.Some patients can achieve pathological complete remission.Combined with total mesorectal excision,the anal preservation rate could be improved and higher overall survival could be obtained.

关 键 词：进展期直肠癌 病理完全缓解 术前新辅助治疗 

分 类 号：R735.37[医药卫生—肿瘤]