中低位直肠癌初诊及新辅助治疗后评估完成度分析:全国多中心真实世界研究  

Analysis of completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer:a national multicenter real-world study

作　　者：李珂璇 肖体先 汪晓东 吴斌 林国乐 国瑀辰 屈明[5] 吴偲 杨晓东[7] 宝音升博尔[8] 王保华[9] 张帆 喻祥旺 牛备战 陆君阳 徐徕 张冠南 孙振 张国友 石彦 蒋宏[9] 田永静[8] 李永翔[7] 姚宏伟 薛军[5] 王权[4] 杨烈 刘骞 肖毅 Li Kexuan;Xiao Tixian;Wang Xiaodong;Wu Bin;Lin Guole;Guo Yuchen;Qu Ming;Wu Si;Yang Xiaodong;Bao Yinshengbo′er;Wang Baohua;Zhang Fan;Yu Xiangwang;Niu Beizhan;Lu Junyang;Xu Lai;Zhang Guannan;Sun Zhen;Zhang Guoyou;Shi Yan;Jiang Hong;Tian Yongjing;Li Yongxiang;Yao Hongwei;Xue Jun;Wang Quan;Yang Lie;Liu Qian;Xiao Yi(Division of Colorectal Surgery,Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Depart-ment of Colorectal Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Gastrointestinal Surgery,West China School of Medicine,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Gastrocolorectal Surgery,General Surgery Center,The First Hospital of Jilin University,Changchun 130021,China;Department of General Surgery,The First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of General Surgery,State Key Lab of Digestive Health,National Clinical Research Center for Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of General Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Gastrointestinal Surgery,Bayannur Hospital,Bayannur 015000,China;Department of Colorectal and Hernia Surgery,Binzhou Medical University Hospital,Binzhou 256603,China;Department of General Surgery,The First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Depart-ment of Gastrointestinal Surgery,Tongliao People′s Hospital,Tongliao 028000,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院基本外科结直肠专业组,北京100730 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [3]四川大学华西临床医学院华西医院胃肠外科,成都610041 [4]吉林大学第一医院普通外科中心胃结直肠外科,长春130021 [5]河北北方学院附属第一医院普通外科,张家口075000 [6]首都医科大学北京友谊医院普通外科,国家消化系统疾病临床研究中心,消化健康国家重点实验室,北京100050 [7]安徽医科大学第一附属医院普通外科,合肥230022 [8]巴彦淖尔市医院胃肠外科,巴彦淖尔015000 [9]滨州医学院附属医院结直肠疝外科,滨州256603 [10]陆军军医大学第一附属医院普通外科,重庆400038 [11]通辽市人民医院胃肠外科,通辽028000

出　　处：《中华消化外科杂志》2025年第1期113-119,共7页Chinese Journal of Digestive Surgery

基　　金：中央高水平医院临床科研专项(2022-PUMCH-C-027);研究型病房卓越临床研究计划(BRWEP2024W034010108)。

摘　　要：目的探讨全国多中心、真实世界中低位直肠癌患者初诊和新辅助治疗后肿瘤评估的完成度。方法采用前瞻性真实世界研究方法。收集2023年5月12日至2024年5月11日北京协和医院等全国47家医学中心行手术治疗的1074例中低位直肠癌患者的临床病理资料。观察指标:(1)中低位直肠癌患者的临床特征。(2)中低位直肠癌患者初诊肿瘤肠镜及病理学评估。(3)中低位直肠癌患者初诊肿瘤影像学评估。(4)中低位直肠癌患者新辅助治疗后肿瘤影像学评估。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(Q1,Q3)表示。计数资料以绝对数和(或)百分比表示。结果(1)中低位直肠癌患者的临床特征。1074例患者中,男713例,女361例;年龄为63(56,70)岁;体质量指数为24(21,26)kg/m2。美国麻醉医师学会分级:Ⅰ级147例,Ⅱ级641例,Ⅲ级157例,Ⅳ级2例,缺失127例。(2)中低位直肠癌患者初诊肿瘤肠镜及病理学评估。1074例患者中,行全程肠镜检查787例(73.28%);行全部4项错配修复蛋白免疫组织化学染色检测评估仅197例(18.34%)。(3)中低位直肠癌患者初诊肿瘤影像学评估。1074例患者中,完成直肠磁共振成像或超声检查评估842例(78.40%),完成胸腹盆腔增强CT检查评估914例(85.10%)。149例行直肠超声检查评估患者中,完成T分期和N分期评估分别为122例(81.88%)和81例(54.36%)。808例行直肠磁共振成像检查评估患者中,完成T分期和N分期评估分别为708例(87.62%)和590例(73.02%)。(4)中低位直肠癌患者新辅助治疗后肿瘤影像学评估。388例行新辅助治疗患者中,完成直肠磁共振成像或超声检查评估332例(85.57%),完成胸腹盆腔增强CT检查评估327例(84.28%)。70例行直肠超声检查评估患者中,完成T分期和N分期评估分别为65例(92.86%)和49例(70.00%)。327例行直肠磁共振成像检查评估患者中,完成T分期和N分期评估分别为246例(75.23%)和228例(69.72%)。Objective To investigate the completion rate of tumor evaluation at initial assessment and after neoadjuvant therapy for mid and low rectal cancer patients in the national multicenter real-world database.Methods The prospective real-world study was conducted.The clinicopathological data of 1074 patients who underwent surgical treatment for mid and low rectal cancer in 47 national medical institutions,including Peking Union Medical College Hospital et al,from May 12,2023 to May 11,2024 were collected.Observation indicators:(1)clinical characteristics of patients with mid and low rectal cancer;(2)initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer;(3)initial imaging evaluation of patients with mid and low rectal cancer;(4)imaging evaluation after neoadjuvant therapy for patients with mid and low rectal cancer.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(Q 1,Q 3).Count data were described as absoluter numbers and/or percentages.Results(1)Clinical characteristics of patients with mid and low rectal cancer.Of the 1074 patients,there were 713 males and 361 females,aged 63(56,70)years.The body mass index of 1074 patients was 24(21,26)kg/m 2.For American Society of Anesthesiologists classification,there were 147 cases of stageⅠ,641 cases of stageⅡ,157 cases of stageⅢ,2 cases of stageⅣ,and there were 127 cases missing data.(2)Initial colonoscopy and pathologic evaluation of tumors in patients with mid and low rectal cancer.Of the 1074 patients,there were 787 cases(73.28%)undergoing complete colonoscopy,and there were only 197 cases(18.34%)undergoing immunohistochemical evaluation of all four mismatch repair proteins.(3)Initial imaging evaluation of patients with mid and low rectal cancer.Of the 1074 patients,there were 842(78.40%)patients completing magnetic resonance imaging(MRI)or ultrasound evaluation,and there were 914(85.10%)patients completing chest,abdomen,and pelvis e

关 键 词：直肠肿瘤 真实世界研究 新辅助治疗 临床分期 评估 

分 类 号：R735.37[医药卫生—肿瘤]