摘要
目的分析新辅助放化疗(nCRT)治疗局部进展期直肠癌的远期疗效及预后影响因素。方法回顾性分析我院普外科2013年1月~2016年1月收治的局部进展期直肠癌病人的临床资料。随访病人5年总体存活率(OS)和无病存活率(DFS),采用单因素分析和Cox回归模型分析影响生存预后的危险因素。结果共纳入完成nCRT并接受根治性手术的局部进展期直肠癌病人97例。中位随访时间39个月(6~83个月),远处转移16例(16.5%),肿瘤复发8例(8.3%)。病人5年OS和DFS分别为77.4%和75.1%,远处转移病人的5年OS显著降低(37.5%vs.76.8%,P=0.022)。单因素分析结果发现,ypTNM分期晚(χ^(2)=11.282,P=0.01)、ypN+(χ^(2)=8.134,P=0.004)以及非病理完全缓解(χ^(2)=4.550,P=0.033)与nCRT后直肠癌病人OS降低显著相关;ypN+(χ^(2)=5.007,P=0.025)和脉管浸润(χ^(2)=3.330,P=0.048)与DFS降低显著相关。Cox多因素分析发现,ypN+是nCRT后病人OS(HR=3.006,95%CI:1.220~7.407,P=0.017)和DFS(HR=2.998,95%CI:1.138~7.894,P=0.026)的独立危险因素。结论 ypN+是局部进展期直肠癌生存预后的独立危险因素,术后针对高危病人进行强化治疗可能有助于改善远期预后。
Objective To further evaluate the long-term survival benefits and prognostic analysis of locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy.Methods Clinical characteristics of locally advanced rectal cancer patients were retrospectively collected from January, 2013 to January, 2016 in the Department of General Surgery of Beijing Chaoyang Hospital.Kaplan-Meier for survival curve and log-rank test for univariate prognostic analysis, Cox proportional hazard model was used for multivariate analysis.Results A total of 97 rectal cancer patients were included.All patients received nCRT and TME.The median follow-up time was 39(6~83) months.The cumulative 5-OS and DFS were 77.4% and 74.1% respectively.Univariate prognostic analysis revealed that advanced ypTNM stage(χ^(2)=11.282,P=0.01),ypN+(χ^(2)=8.134,P=0.004) and non-pCR(χ^(2)=4.550,P=0.033) patients had a worse OS,while ypN+(χ^(2)=5.007,P=0.025) and lymphvascular invasion(χ^(2)=3.330,P=0.048) were significantly associated with decreased DFS.Multivariate analysis showed that ypN stage was independent risk factor for both OS(HR=3.006,95%CI:1.220~7.407,P=0.017)and DFS(HR=2.998,95%CI:1.138~7.894,P=0.026).Conclusion ypN+ was independent risk factor for both OS and DSF for locally advanced rectal cancer who received neoadjuvant chemoradiotherapy, and consolidation therapy after nCRT might be benefical for patients with high risk factors.
作者
李干斌
韩加刚
王振军
魏广辉
渠浩
翟志伟
易秉强
马华崇
杨勇
王建良
李竹林
LI Ganbin;HAN Jiagang;WANG Zhenjun(Department of General Surgery,Beijing Chaoyang Hosptial,Capital Medical University,Beijing 100020,China)
出处
《临床外科杂志》
2021年第5期422-427,共6页
Journal of Clinical Surgery
关键词
新辅助放化疗
局部进展期直肠癌
远期疗效
预后因素
neoadjuvant chemoradiotherapy
locally advanced rectal cancer
long-term survival benefits
prognostic analysis
