影响中低位直肠癌新辅助治疗敏感性的预测因素分析  

Analysis of the predictive factors affecting the sensitivity of neoadjuvant chemoradiotherapy for middle-low rectal cancer

作　　者：李嘉根 张弘韬 宋哲宇 房学东[1] 吴元玉[1] LI Jiagen;ZHANG Hongtao;SONG Zheyu;FANG Xuedong;WU Yuanyu(Department of Gastrointestinal and Colorectal Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,China;Changchun Guowen Hospital,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院胃肠结直肠外科,长春130033 [2]长春国文医院,长春130033

出　　处：《长春中医药大学学报》2025年第2期189-193,共5页Journal of Changchun University of Chinese Medicine

基　　金：吉林省卫生健康委科技能力提升计划项目(2020Q023)。

摘　　要：目的 探讨影响中低位直肠癌新辅助治疗(nCRT)敏感性的预测因素,评估相关因素的预测效能,使患者选择最佳的个体化治疗方案。方法 回顾性分析2022年9月-2024年9月在吉林大学中日联谊医院行术前新辅助治疗的90例直肠癌患者的临床资料,根据病理消退程度分成治疗效果好组(35例)与治疗效果差组(55例)。对2组临床资料进行单因素分析,对其中差异有统计学意义的因素进行多因素Logistic回归分析,并进行受试者工作特征曲线(ROC)分析,评价相关因素预测效能。结果 单因素分析结果显示,nCRT前血清癌胚抗原(CEA)≤5 μg·L^(-1)(P=0.001)、nCRT至手术时间间隔≥6周(P=0.022)、肿瘤最长径<5 cm(P=0.031)和巩固化疗(P=0.003)与新辅助治疗高敏感性有关;多因素回归分析结果显示,nCRT前CEA≤5 μg·L^(-1)(P<0.001)、肿瘤最长径<5 cm(P=0.016)和巩固化疗(P=0.003)是影响新辅助治疗敏感性的独立因素。ROC分析结果显示,血清癌胚抗原(CEA)≤5 μg·L^(-1)、肿瘤最长径<5 cm、巩固化疗三者联合预测的曲线下面积(AUC)为0.836,CEA值和巩固化疗联合预测的曲线下面积(AUC)为0.834,联合预测的收益率相较于单独预测的收益率高。结论 针对进展期中低位直肠癌的患者,nCRT前CEA≤5 μg·L^(-1)、肿瘤最长径<5 cm和巩固化疗均是影响新辅助治疗敏感性的重要指标,并且是预测患者肿瘤消退程度的重要因素,nCRT前CEA值有较高的预测效能。因此临床上需要综合考量患者病情,制定个体化治疗方案,使患者获得最大收益。Objective To explore the predictors of affecting the sensitivity of neoadjuvant chemoradiotherapy(nCRT)for middle-low rectal cancer,and to evaluate the predictive efficacy of related factors,so that patients can choose the best individualized treatment plan.Methods The clinical data of 90 patients with rectal cancer who underwent preoperative neoadjuvant therapy in China-Japan Union Hospital of Jilin University from September 2022 to September 2024 were retrospectively analyzed.According to the degree of pathological regression,the patients were divided into the good treatment effect group(35 cases)and the poor treatment effect group(55 cases).The clinical data of two groups were analyzed by univariate analysis.Multivariate logistic regression analysis on factors with statistically significant differences was performed,and receiver-operating characteristic curve(ROC curve)analysis was used to evaluate the predictive efficacy of relevant factors.Results Univariate analysis showed that-1 carcinoembryonic antigen(CEA)before nCRT≤5μg·L^(-1)(P=0.001),interval between nCRT and surgery≥6 weeks(P=0.022),maximum tumor diameter<5cm(P=0.031)and consolidation chemotherapy(P=0.003)were associated with high sensitivity of-1 nCRT.Multivariate regression analysis showed that CEA≤5μg·L^(-1) before nCRT(P<0.001),maximum tumor diameter<5cm(P=0.016)and consolidation chemotherapy(P=0.003)were independent factors affecting the sensitivity of nCRT.ROC curve analysis showed that area under the curve(AUC)of the combination of CEA≤5μg·L^(-1),tumor maximum diameter<5cm and consolidation chemotherapy was 0.836,and AUC of the combination of CEA value and consolidation chemotherapy was 0.834.The yield of combined prediction was higher than that of single prediction.Conclusion For patients with advanced middle-low rectal cancer,CEA before nCRT≤5μg·L^(-1),tumor diameter<5cm and consolidation chemotherapy are important factors affecting the sensitivity of nCRT and predicting the degree of tumor regression.CEA value before nCRT

关 键 词：直肠癌 新辅助放化疗 敏感性 肿瘤消退 癌胚抗原 

分 类 号：R735.37[医药卫生—肿瘤]