局部进展期直肠癌新辅助放化疗后病理完全缓解临床相关因素探究
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摘要
目的探讨局部进展期直肠癌新辅助放化疗后病理完全缓解(pCR)的临床相关因素。方法回顾性分析2013年1月至2018年5月期间四川省肿瘤医院肠道外科病区收治的117例局部进展期直肠癌新辅助放化疗及手术的临床资料,采用单因素分析及logistic二分类多因素回归分析法研究pCR的临床相关因素。结果 117例患者全部完成新辅助放化疗及根治手术,其中19例(16.24%)患者达到pCR。单因素分析结果显示,性别为女性(P=0.024),年龄较年轻(P=0.042),放疗前CEA <5 ug/L(P=0.015),无吸烟史(P=0.008),无饮酒史(P=0.037),肿瘤距肛缘距离大于6 cm(P=0.048)和局部进展期直肠癌新辅助放化疗后高pCR率有关。多因素回归分析结果显示,放疗前CEA <5 ug/L(P=0.039)和肿瘤距肛缘距离> 6 cm(P=0.043)是影响局部进展期直肠癌新辅助放化疗后pCR率的独立因素。结论放疗前CEA水平和肿瘤距肛缘距离是影响局部进展期直肠癌新辅助放化疗后pCR率的相关临床因素。
Objective To investigate the clinical related factors of pathologic complete response(pCR) after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer. Methods The clinical data of 117 patients with locally advanced rectal cancer treated in intestinal surgery ward of Sichuan Cancer Hospital from January 2013 to May 2018 were retrospectively analyzed. The clinical related factors of pathologic complete response were studied by univariate analysis and logistic binary classification multivariate regression analysis. Results A total of 117 patients were enrolled in the study. All of them completed neoadjuvant radiotherapy, chemotherapy and radical surgery. Nineteen patients(16.24%) achieved pathologic complete response. Univariate analysis showed that the sex was female(P=0.024), the age was younger(P=0.042), the level of CEA before radiotherapy was less than 5 ug/L(P=0.015), no smoking history(P=0.008), no drinking history(P=0.037), the distance between tumor and anal margin was greater than 6 cm(P=0.048) and the high pathologic complete response after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer. The rate is related. Multivariate regression analysis showed that the CEA level before radiotherapy was less than 5 ug/L(P=0.039) and the distance between the tumor and the anal margin was more than 6 cm(P=0.043) were independent factors affecting the pathologic complete response rate of locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy. Conclusion The level of CEA before radiotherapy and the distance between the tumor and the anal margin may be related to the rate of pathologic complete response after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer.
Objective To investigate the clinical related factors of pathologic complete response(pCR) after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer. Methods The clinical data of 117 patients with locally advanced rectal cancer treated in intestinal surgery ward of Sichuan Cancer Hospital from January 2013 to May 2018 were retrospectively analyzed. The clinical related factors of pathologic complete response were studied by univariate analysis and logistic binary classification multivariate regression analysis. Results A total of 117 patients were enrolled in the study. All of them completed neoadjuvant radiotherapy, chemotherapy and radical surgery. Nineteen patients(16.24%) achieved pathologic complete response. Univariate analysis showed that the sex was female(P=0.024), the age was younger(P=0.042), the level of CEA before radiotherapy was less than 5 ug/L(P=0.015), no smoking history(P=0.008), no drinking history(P=0.037), the distance between tumor and anal margin was greater than 6 cm(P=0.048) and the high pathologic complete response after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer. The rate is related. Multivariate regression analysis showed that the CEA level before radiotherapy was less than 5 ug/L(P=0.039) and the distance between the tumor and the anal margin was more than 6 cm(P=0.043) were independent factors affecting the pathologic complete response rate of locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy. Conclusion The level of CEA before radiotherapy and the distance between the tumor and the anal margin may be related to the rate of pathologic complete response after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer.
引文
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[10]Das P,Skibber JM,Rodriguez-Bigas MA,et al.Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer[J].Cancer,2007,109(9):1750-1755.
[11]阿衣古丽·哈,帕丽达·阿皮孜,伊斯刊达尔·阿布力米提,等.直肠癌新辅助放化疗后病理完全缓解的临床因素分析[J].中华放射肿瘤学杂志,2014,23(1):5-8.
[2]窦维龙.局部进展期直肠癌新辅助治疗后病理消退的多因素分析以及预后意义[D].上海:第二军医大学,2013.
[3]Zorcolo L,Rosman As,Restivo A,et al.Complete pathologic response after combined modality treatment for rectal cancer and long-term survival:a meta-analysis[J].Ann Surg Oncol,2012,19(11):2822-2832.
[4]Wasmuth HH,Rekstad LC,Trano G.The outcome and the frequency of pathological complete response after neoadjuvant radiotherapy in curative resections for advanced rectal cancer:a population-based study[J].Colorectal Dis,2016,18(1):67-72.
[5]BellucoC1,DePaoliA,CanzonieriV,et al.Long-omplete pathologic response after neoadjuvant chemoradiation for cT3 rectal cancer:implications for local excision surgical strategies.Ann Surg Oncol,2011,18(13):3686-3693.
[6]胡海,燕锦,刘超,等.预测局部进展期直肠癌新辅助放化疗后病理完全缓解的临床因素研究[J].四川医学,2017,38(8):938-941.
[7]Maas M,Nelemans PJ,Valentini V,et al.Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer:a pooled analysis of individual patient data[J].Lancet Oncol,2010,11(9):835-844.
[8]Yoon SM,Kim DY,Kim TH,et al.Clinical parameters predicting pathologic tumor response after preoperative chemoradiotherapy for rectal cancer[J].Int J Radiat Oncol Biol Phys,2007,69(4):1167-1172.
[9]孙艳武,池畔,徐本华,等.直肠癌新辅助放化疗后病理完全缓解预测因素分析[J].中华胃肠外科杂志,2014,17(6):556-560.
[10]Das P,Skibber JM,Rodriguez-Bigas MA,et al.Predictors of tumor response and downstaging in patients who receive preoperative chemoradiation for rectal cancer[J].Cancer,2007,109(9):1750-1755.
[11]阿衣古丽·哈,帕丽达·阿皮孜,伊斯刊达尔·阿布力米提,等.直肠癌新辅助放化疗后病理完全缓解的临床因素分析[J].中华放射肿瘤学杂志,2014,23(1):5-8.