引用本文:杜锦波,邱文龙,梅世文,胡 刚,权继传,庄 孟,王锡山,汤坚强.局部进展期直肠癌新辅助同步放化疗病理完全缓解的影响因素[J].中国临床新医学,2024,17(5):485-490.
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局部进展期直肠癌新辅助同步放化疗病理完全缓解的影响因素
杜锦波,邱文龙,梅世文,胡 刚,权继传,庄 孟,王锡山,汤坚强
国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京 100021
摘要:
[摘要] 目的 探讨局部进展期直肠癌经新辅助同步放化疗获病理完全缓解(pCR)的影响因素。方法 回顾性收集中国医学科学院北京协和医学院肿瘤医院2013年1月至2017年5月收治的226例局部进展期直肠癌患者的临床资料,均接受新辅助同步放化疗并接受手术治疗。通过多因素logistic回归分析pCR与肿瘤位置、肿瘤T分期、肿瘤最大直径、肠壁外血管侵犯(EMVI)、直肠系膜筋膜(MRF)侵犯等临床病理因素的关联性,比较pCR组与非pCR组无病生存期(DFS)及总生存期(OS)的差异。结果 术前T分期为T3期[OR(95%CI)=3.978(1.227~12.897),P=0.021]、肿瘤最大直径<4 cm[OR(95%CI)=2.439(1.046~5.685),P=0.039]、肿瘤距齿状线≤5 cm[OR(95%CI)=3.154(1.229~8.094),P=0.017]是局部进展期直肠癌患者经新辅助同步放化疗后获得pCR的独立影响因素。pCR组患者的5年DFS(82.1% vs 67.6%,P=0.046)和OS(87.2% vs 68.5%,P=0.015)均优于非pCR组患者。结论 术前T3分期、肿瘤最大直径<4 cm、肿瘤距齿状线≤5 cm直肠癌患者是新辅助同步放化疗的潜在获益人群,并且获pCR患者的预后更好。
关键词:  直肠癌  新辅助同步放化疗  病理完全缓解
DOI:10.3969/j.issn.1674-3806.2024.05.02
分类号:R 735.3+7
基金项目:北京市自然科学基金项目(编号:L222054,4232058)
The factors influencing pathological complete response to neoadjuvant concurrent chemoradiotherapy in locally advanced rectal cancer
DU Jinbo, QIU Wenlong, MEI Shiwen, HU Gang, QUAN Jichuan, ZHUANG Meng, WANG Xishan, TANG Jianqiang
Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center of Cancer, Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Abstract:
[Abstract] Objective To explore the factors influencing pathological complete response(pCR) to neoadjuvant concurrent chemoradiotherapy in locally advanced rectal cancer. Methods The clinical data of 226 patients with locally advanced rectal cancer who were admitted to Cancer Hospital Chinese Academy of Medical Sciences and Peking Union Medical College from January 2013 to May 2017 were retrospectively collected. All of the patients received neoadjuvant concurrent chemoradiotherapy and surgery. Multivariate logistic regression was used to analyze the correlation between pCR and clinicopathologic factors such as tumor location, tumor T stage, maximum tumor diameter, extramural vascular invasion(EMVI) and mesorectal fascia(MRF) invasion. The differences in disease-free survival(DFS) and overall survival(OS) were compared between pCR group and non-pCR group. Results The preoperative T stage being T3 stage[OR(95%CI)=3.978(1.227-12.897), P=0.021], the maximum tumor diameter less than 4 cm[OR(95%CI)=2.439(1.046-5.685), P=0.039] and distance from tumor to dentate line less than or equal to 5 cm[OR(95%CI)=3.154(1.229-8.094), P=0.017] were independent influencing factors of obtaining pCR in locally advanced rectal cancer patients receiving neoadjuvant concurrent chemoradiotherapy. The 5-year DFS(82.1% vs 67.6%, P=0.046) and OS(87.2% vs 68.5%, P=0.015) in the patients of the pCR group were better than those in the patients of the non-PCR group. Conclusion The rectal cancer patients with preoperative T3 stage, the maximum tumor diameter less than 4 cm and the distance from tumor to dentate line less than or equal to 5 cm can benefit from neoadjuvant concurrent chemoradiotherapy, and the patients who achieve pCR obtain better prognosis.
Key words:  Rectal cancer  Neoadjuvant concurrent chemoradiotherapy  Pathological complete response(pCR)