术前新辅助化疗对低位直肠癌患者的临床疗效分析
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摘要
目的观察新辅助化疗对低位直肠癌患者的疗效及安全性。方法 80例局部进展期低位直肠癌患者随机分为对照组和试验组,每组40例。对照组直接进行腹腔镜下根治术,试验组先进行新辅助化疗后再行手术治疗。观察试验组的化疗疗效,两组的R0切除率、保肛率、复发率、生存率及术后并发症。结果试验组新辅助化疗总有效率为52. 5%(21/40)。试验组和对照组的R0切除率分别为87. 5%和67. 5%,保肛率分别为85%和65%,差异均有统计学意义(P <0. 05)。试验组术后5年生存率为70. 0%,对照组为47. 5%,差异有统计学意义(P <0. 05)。两组在术后吻合口出血、吻合口瘘、肠梗阻、尿路感染的发生率上差异均无统计学意义(P> 0. 05)。结论新辅助化疗治疗低位直肠癌可提高保肛率、改善患者生存率,且不会增加术后并发症的发生,值得临床推广。
Objective To investigate the therapeutic effect and safety of neoadjuvant chemotherapy for low rectal carcinoma. Methods 80 patients with locally advanced low rectal cancer were randomly divided into a control group and a experimental group,40 cases per group. The experimental group was given neoadjuvant chemotherapy before operation,while the control group was given operation directly. The efficacy of chemotherapy in the experimental group,the rate of R0 cutting、sphincter preservation、recurrence、survival and postoperative complications were observed. Results The efficacy of chemotherapy in the experimental group was 52. 5%( 21/40). R0 cutting rate of experimental group was 87. 5%,and the rate of sphincter preservation was 85%,which were all higher than 67. 5% and 65% of control group,the difference between groups was statistically significant( P< 0. 05). The five-year survival rate of the experimental group was 70%,which was higher than that of the control group( 47. 5%). The postoperative complications were no statistically difference between the two groups. Conclusion Neoadjuvant chemotherapy can improve the rate of sphincter preservation and survival in treatment of locally advanced low rectal cancer,which has a certain clinical application value.
Objective To investigate the therapeutic effect and safety of neoadjuvant chemotherapy for low rectal carcinoma. Methods 80 patients with locally advanced low rectal cancer were randomly divided into a control group and a experimental group,40 cases per group. The experimental group was given neoadjuvant chemotherapy before operation,while the control group was given operation directly. The efficacy of chemotherapy in the experimental group,the rate of R0 cutting、sphincter preservation、recurrence、survival and postoperative complications were observed. Results The efficacy of chemotherapy in the experimental group was 52. 5%( 21/40). R0 cutting rate of experimental group was 87. 5%,and the rate of sphincter preservation was 85%,which were all higher than 67. 5% and 65% of control group,the difference between groups was statistically significant( P< 0. 05). The five-year survival rate of the experimental group was 70%,which was higher than that of the control group( 47. 5%). The postoperative complications were no statistically difference between the two groups. Conclusion Neoadjuvant chemotherapy can improve the rate of sphincter preservation and survival in treatment of locally advanced low rectal cancer,which has a certain clinical application value.
引文
[1]崔宗良,孙旭,宋希林,等. XELOX新辅助化疗治疗局部进展期低位直肠癌初步研究〔J〕.中华肿瘤防治杂志,2017,24(15):1091-1093.
[2] Eisenhauer E A,Therasse P,Bogaerts J,et al. New response evaluation criteria in solid tumours:revised RECIST guideline(version 1. 1)〔J〕. Eur J Cancer,2009,45(2):228-247.
[3] Watanabe T,Itabashi M,Shimada Y,et al. Japanese Society for Cancer of the Colon and Rectum(JSCCR)Guidelines2014 for treatment of colorrectal cancer〔J〕. Int J Clin Oncol,2015,20(2):207-239.
[4]汪建平.低位直肠癌术式选择及评价〔J〕.中国实用外科杂志,2017,37(6):593-595.
[5]张贻超,吴华平,陈胜君,等.腹腔镜联合新辅助化疗治疗中低位直肠癌的疗效观察〔J〕.实用癌症杂志,2015,30(6):849-852.
[6]韩文峰,张昕,苏国宏,等.低位直肠癌诊治新策略〔J〕.西北国防医学杂志,2018,39(8):555-560.
[7]朱伟鹏.新辅助化疗在低位直肠癌治疗中的应用价值〔D〕.广西医科大学,2014.
[8]杨梅健,宝莹娜,赵建国.直肠癌的新辅助治疗〔J〕.实用肿瘤学杂志,2016,30(5):453-457.
[9] Fakih MG,Rajput A,Yang GY,et al. A phase study of weekly intravenous oxaliplatin in combination with oral daily capecitabine and radiation therapy in the neoadjuvant treatment of rectal a denocarcinoma〔J〕. Int J Radiat Oncol Biol Phys,2006,65(5):1462-1470.
[10] Taishi Hata,Hidekazu Takahashi,Daisuke Sakai,et al. Neoadjuvant Cape Ox therapy followed by sphincter-preserving surgery for lower rectal cancer〔J〕. Surgery Today,2017,11(47):1372-1377.
[11] Nagtegaal ID,Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer?〔J〕. J Clin Oncol,2008,26(2):303-312.
[2] Eisenhauer E A,Therasse P,Bogaerts J,et al. New response evaluation criteria in solid tumours:revised RECIST guideline(version 1. 1)〔J〕. Eur J Cancer,2009,45(2):228-247.
[3] Watanabe T,Itabashi M,Shimada Y,et al. Japanese Society for Cancer of the Colon and Rectum(JSCCR)Guidelines2014 for treatment of colorrectal cancer〔J〕. Int J Clin Oncol,2015,20(2):207-239.
[4]汪建平.低位直肠癌术式选择及评价〔J〕.中国实用外科杂志,2017,37(6):593-595.
[5]张贻超,吴华平,陈胜君,等.腹腔镜联合新辅助化疗治疗中低位直肠癌的疗效观察〔J〕.实用癌症杂志,2015,30(6):849-852.
[6]韩文峰,张昕,苏国宏,等.低位直肠癌诊治新策略〔J〕.西北国防医学杂志,2018,39(8):555-560.
[7]朱伟鹏.新辅助化疗在低位直肠癌治疗中的应用价值〔D〕.广西医科大学,2014.
[8]杨梅健,宝莹娜,赵建国.直肠癌的新辅助治疗〔J〕.实用肿瘤学杂志,2016,30(5):453-457.
[9] Fakih MG,Rajput A,Yang GY,et al. A phase study of weekly intravenous oxaliplatin in combination with oral daily capecitabine and radiation therapy in the neoadjuvant treatment of rectal a denocarcinoma〔J〕. Int J Radiat Oncol Biol Phys,2006,65(5):1462-1470.
[10] Taishi Hata,Hidekazu Takahashi,Daisuke Sakai,et al. Neoadjuvant Cape Ox therapy followed by sphincter-preserving surgery for lower rectal cancer〔J〕. Surgery Today,2017,11(47):1372-1377.
[11] Nagtegaal ID,Quirke P. What is the role for the circumferential margin in the modern treatment of rectal cancer?〔J〕. J Clin Oncol,2008,26(2):303-312.