Ⅲ期结肠癌神经侵犯对不同化疗时长生存获益的影响  

Impact of perineural invasion upon chemotherapy duration and survival benefit in stageⅢcolon cancer

作　　者：陈建勋 张炜力 王炜锋 李济宾 伍小军[2] 卢震海[2] 许东波 林俊忠[2] 彭健宏[2] Chen Jianxun;Zhang Weili;Wang Weifeng;Li Jibin;Wu Xiaojun;Lu Zhenhai;Xu Dongbo;Lin Junzhong;Peng Jianhong(Department of Gastrointestinal Surgery,Longyan First Affiliated Hospital of Fujian Medical University,Longyan 364000,China;Department of Colorectal Surgery,Sun Yat-sen University Cancer Center,State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangzhou 510060,China;Department of Clinical Research,Sun Yat-sen University Cancer Center,Guangzhou 510060,China)

机构地区：[1]福建医科大学附属龙岩第一医院胃肠外科,福建364000 [2]中山大学肿瘤防治中心结直肠科、华南恶性肿瘤防治全国重点实验室、广东省恶性肿瘤临床医学研究中心,广州510060 [3]中山大学肿瘤防治中心临床研究部,广州510060

出　　处：《中华胃肠外科杂志》2025年第1期58-66,共9页Chinese Journal of Gastrointestinal Surgery

基　　金：广州市科技计划项目(2023A04J1078);希思科朝阳肿瘤研究基金(Y-Young20220023、Y-Gilead2024-PT-0006)。

摘　　要：目的研究神经侵犯对Ⅲ期结肠术后辅助化疗时长选择的指导价值。方法本研究采用回顾性队列研究方法。分析2008年4月至2020年6月期间,在中山大学肿瘤防治中心以及福建医科大学附属龙岩第一医院接受根治性手术、术后进行了至少3个月CapOX方案辅助治疗、病理资料完整且末次化疗后至少接受12个月随访的426例Ⅲ期结肠癌患者,其中男性231例,中位年龄59(50~67)岁,263例肿瘤位于右半结肠;术后病理提示,107例(25.12%)存在神经侵犯,131例(30.75%)患者存在脉管癌栓。所有患者在术后均接受了4程及以上的术后CapOX辅助化疗,其中193例接受了8疗程的辅助化疗,233例接受4~7疗程辅助化疗。分析神经侵犯状态和辅助化疗时长对无病生存(DFS)的影响,并在不同危险度分层(参考IDEA研究提出的标准:高危:T4,N2或者T4N2;低危:T3N1)和不同神经侵犯状态的亚组中,进一步分析辅助化疗时长对预后的影响。结果全组患者的中位随访时间为94.00(55.27~128.80)个月。多因素Cox分析提示,pT4分期(HR=2.457,95%CI:1.499~4.029,P<0.001)以及术后病理证实神经侵犯(HR=2.465,95%CI:1.519~4.000,P<0.001)是本组患者5年DFS的独立危险因素,但辅助化疗时长对DFS无显著影响(P>0.05)。在神经侵犯阳性亚组中,接受8程与4~7程CapOX术后辅助化疗患者的5年DFS分别为86.90%与58.22%,差异有统计学意义(P<0.001)。神经侵犯阴性组中,接受8程与4~7程辅助化疗患者的5年DFS分别为88.66%与90.99%,差异无统计学意义(P=0.929)。在IDEA高危且神经侵犯阳性的患者中,接受8程与4~7程辅助化疗患者的5年DFS分别为91.81%与50.66%,差异有统计学意义(P=0.003);在IDEA高危而神经侵犯阴性的患者中,接受8程与4~7程CapOX术后辅助化疗患者的5年DFS分别为82.28%与87.32%,差异无统计学意义(P=0.806)。在IDEA低危患者中,无论神经侵犯阳性还是阴性,均未观察到接受8程与4~7程CapOX术后辅助化疗患者�Objective To investigate the prognostic impact of perineural invasion in patients with stageⅢcolon cancer and to clarify its guidance value for the duration of postoperative adjuvant chemotherapy.MethodsThis study employed a retrospective cohort study method.It analyzed 426 patients with stageⅢcolon cancer who underwent radical surgery at Sun Yat-sen University Cancer Center and Longyan First Affiliated Hospital of Fujian Medical University,between April 2008 and June 2020.Inclusion criteria:patients received at least 3 months of adjuvant CapeOX therapy post-surgery,had complete pathological data,and were followed up for at least 12 months after the last chemotherapy.Among these patients,231 were male,the median age was 59(50~67)years,and 263 tumors were located in the right-sided colon.Postoperative pathology indicated that 107 cases(25.12%)had neural invasion,and 131 patients(30.75%)had vascular tumor thrombus.All patients received at least 4 cycles of postoperative CapeOX adjuvant chemotherapy,with 193 patients receiving 8 cycles and 233 patients receiving 4 to 7 cycles of adjuvant chemotherapy.The study analyzed the impact of neural invasion status and the duration of adjuvant chemotherapy on disease-free survival(DFS).Furthermore,within subgroups stratified by different risk levels(referencing the criteria proposed by the IDEA study:high risk:T4,N2 or T4N2;low risk:T3N1)and different neural invasion statuses,the impact of the duration of adjuvant chemotherapy on prognosis was analyzed.ResultsThe median follow-up time for the entire cohort was 94.00 months(55.27-128.80 months).Multivariate Cox analysis indicated that pathological T stage T4(HR=2.457,95%CI:1.499-4.029,P<0.001)and postoperative pathological confirmation of perineural invasion(HR=2.465,95%CI:1.519-4.000,P<0.001)were independent adverse prognostic factors for 5-year DFS.In the perineural invasion-positive group,the 5-year DFS for patients who received 8 cycles of postoperative adjuvant CapeOX chemotherapy was 86.90%,compared to 58.22%for thos

关 键 词：结肠肿瘤 神经侵犯 辅助化疗 

分 类 号：R735.35[医药卫生—肿瘤]