局部进展期直肠癌新辅助放化疗后病理完全反应相关临床因素的研究
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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反应(pathologic complete response,pCR)相关的临床因素。方法回顾性分析新疆医科大学附属肿瘤医院2010年1月1日-2017年12月31日收治的接受新辅助放化疗联合全直肠系膜切除术(total mesorectal excision,TME)治疗的289例直肠癌患者资料,分为pCR组(n=53,18.3%)和非pCR组(n=236,81.7%)。采用单因素和二元Logistic回归分析法、ROC曲线评估与pCR反应相关的临床因素。结果治疗前癌胚抗原(carcinoembryonic antigen,CEA)、肿瘤最大径是影响pCR反应的独立因素,治疗前糖链抗原72-4(carbohydrate antigen 72-4,CA72-4)(P=0.004)、分化程度(P=0.012)对pCR反应有影响;ROC曲线结果显示治疗前平均表观扩散系数(apparent diffusion coefficient,ADC)值、ADC值增长率零阶矩曲线下面积(AUC)分别为0.648、0.746。结论治疗前CEA≤5 ng/mL、肿瘤最大径较短(≤3 cm)的患者获得pCR的机会更大,治疗前平均ADC值和增长比率在预测pCR中具有一定价值。
Objective To investigate the clinical factors associated with pathological complete response(pCR) in locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy. Methods A retrospective analysis was made of 289 cases of rectal cancer treated with neoadjuvant radiotherapy and chemotherapy combined with total mesorectal excision from January 1, 2010 to December 31, 2017. The patients were divided into pCR group(n=53, 18.3%) and non-pCR group(n=236, 81.7%). Univariate and binary logistic regression analysis and ROC curve were used to evaluate the clinical factors related to pCR reaction. Results Before treatment, CEA(carcinoembryonic antigen) and maximum diameter of tumors were independent factors affecting pCR. Before treatment, CA72-4(P=0.004) and differentiation degree(P=0.012) had effects on pCR. The results of ROC curve showed that the ADC(apparent diffusion coefficient) and area under curve(AUC) of zero-order moment of ADC average growth rate before treatment were 0.648 and 0.746 respectively. Conclusion Before treatment, patients with CEA ≤5 ng/mL and shorter tumor maximum diameter(≤3 cm) had a greater chance of obtaining pCR. Average ADC value and growth rate before treatment are valuable in predicting pCR.
Objective To investigate the clinical factors associated with pathological complete response(pCR) in locally advanced rectal cancer after neoadjuvant radiotherapy and chemotherapy. Methods A retrospective analysis was made of 289 cases of rectal cancer treated with neoadjuvant radiotherapy and chemotherapy combined with total mesorectal excision from January 1, 2010 to December 31, 2017. The patients were divided into pCR group(n=53, 18.3%) and non-pCR group(n=236, 81.7%). Univariate and binary logistic regression analysis and ROC curve were used to evaluate the clinical factors related to pCR reaction. Results Before treatment, CEA(carcinoembryonic antigen) and maximum diameter of tumors were independent factors affecting pCR. Before treatment, CA72-4(P=0.004) and differentiation degree(P=0.012) had effects on pCR. The results of ROC curve showed that the ADC(apparent diffusion coefficient) and area under curve(AUC) of zero-order moment of ADC average growth rate before treatment were 0.648 and 0.746 respectively. Conclusion Before treatment, patients with CEA ≤5 ng/mL and shorter tumor maximum diameter(≤3 cm) had a greater chance of obtaining pCR. Average ADC value and growth rate before treatment are valuable in predicting pCR.
引文
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[18] 余涛,曹祥龙,吴国举,等.直肠癌新辅助放化疗后病理完全缓解的临床预测因素分析[J].中华医学杂志,2016,96(16):1274-1277.
[19] 李天梁,徐亮,李蜀华,等.MRI、CT与超声内镜在直肠癌诊断及术前分期中的临床意义[J].中国全科医学,2017,20(S3):415-417.
[20] 沈璐,唐菲,林翌,等.3.0T表观扩散系数与直肠癌病理分型及预后指标的相关性[J].肿瘤影像学,2017,26(1):43-48.
[2] 王靖雯,朱骥.局部进展期直肠癌患者的非手术治疗[J].肿瘤综合治疗电子杂志,2018,4(4):31-37.
[3] 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.
[4] 陶俊,王贵和.局部进展期直肠癌新辅助放化疗后病理完全缓解的预测因素分析[J].临床外科杂志,2018,26(10):756-759.
[5] 陈佳艳,张弛,余静,等.CEA在评估直肠癌新辅助放化疗后肿瘤退缩中的意义[J].中华结直肠疾病电子杂志,2015,(6):613-616.
[6] 阿衣古丽·哈热,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.
[7] 李玉强,裴谦,裴海平.原发灶肿瘤体积对局部进展期直肠癌新辅助放化疗后病理完全反应的预测价值[J].中国普通外科杂志,2017,26(5):626-635.
[8] 刘英强,陈淅涓,黄涛,等.中低位局部进展期直肠癌新辅助同步放化疗敏感性预测的研究[J].中华实验外科杂志,2015,32(7):1704-1706.
[9] ZHANG C,YE F,LIU Y,et al.Morphologic predictors of pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J].Oncotarget,2018,9(4):4862-4874.
[10] 克迪雅·艾海提,徐怡.血清肿瘤标志物在直肠癌诊断中的应用[J].新疆医科大学学报,2013,36(9):1301-1303.
[11] 彭海花,王成涛,余昕,等.局部晚期直肠癌术前同期放化疗达pCR者预后分析[J].中华放射肿瘤学杂志,2016,25(10):1079-1082.
[12] YANG K L,YANG S H,LIANG W Y,et al.Carcinoembryonic antigen (CEA) level,CEA ratio,and treatment outcome of rectal cancer patients receiving pre-operative chemoradiation and surgery[J].Radiat Oncol,2013,8:43.
[13] WALLIN U,ROTHENBERGER D,LOWRY A,et al.CEA-A predictor for pathologic complete resp after neoadjuvant therapy for rectal cancer[J].Dis Colon Rectum,2013,56(7):859-868.
[14] LEE J H,KIM S H,JANG H S,et al.Preoperative elevation of carcinoembryonic antigen predicts poor tumor response and frequent distant recurrence for patients with rectal cancer who receive preoperative chemoradiotherapy and total mesorectal excision:amulti-institutional analysis in an Asian population[J].Int J Colorectal Dis,2013,28:511-517.
[15] 魏梅.癌胚抗原升高在良恶性疾病中诊断价值研究[J].医学信息,2016,29(18):118-119.
[16] ZHANG G F,DENG W M,IMMUNOLOGY D O.Clinical significance of serum CA72-4 in patients with digestive system cancers[J].WCJD,2015,23(5):862-865.
[17] 刘英强,陈淅涓,韩广森,等.中低位局部进展期直肠癌新辅助放化疗后病理完全缓解预测因素研究[J].中华实验外科杂志,2017,34(9):1565-1567.
[18] 余涛,曹祥龙,吴国举,等.直肠癌新辅助放化疗后病理完全缓解的临床预测因素分析[J].中华医学杂志,2016,96(16):1274-1277.
[19] 李天梁,徐亮,李蜀华,等.MRI、CT与超声内镜在直肠癌诊断及术前分期中的临床意义[J].中国全科医学,2017,20(S3):415-417.
[20] 沈璐,唐菲,林翌,等.3.0T表观扩散系数与直肠癌病理分型及预后指标的相关性[J].肿瘤影像学,2017,26(1):43-48.