摘要
目的探讨新辅助治疗对中下段局部进展期直肠癌术后淋巴结获取数目的影响。方法回顾性研究2005年1月至2008年6月120例行根治手术切除的中下段进展期直肠癌[T2-4和（或）N1-2M0]病例的临床资料。患者中行新辅助治疗联合手术切除者54例（研究组），直接行根治性手术切除者66例（对照组），新辅助治疗的手段包括术前总剂量50Gy的盆腔放疗和5-Fu为基础的同步化疗。根据患者临床病理分期等特点，比较新辅助治疗前后临床分期的变化，比较两组总淋巴结获取数和阳性淋巴结获取数的差别。结果研究组新辅助治疗后，30例（56％）出现了T分期或N分期的降期；对照组的总淋巴结数为（14±7）个、阳性淋巴结数为（2．2±3．7）个，而研究组中手术标本获取的总淋巴结数为（9±6）个、阳性淋巴结数（0．7±2．4）个，均明显少于对照组（P〈0．01）。结论新辅助治疗在降低肿瘤T分期的同时，可以明显降低直肠癌术后的区域淋巴结获取率和阳性淋巴结的获取率；对于接受了新辅助治疗的直肠癌病例，获取尽可能多的评估淋巴结是有必要的。
Objective To study the impact of neoadjuvant therapy on lymph nodes retrieval in locally advanced mid-low rectal carcinoma. Methods Data collected from 120 patients with locally advanced mid-low rectal cancer （ T2-4 and/or N1-2 M0 ） treated from January 2005 to June 2008 was investigated. The patients were divided into two groups： the study group （n = 54 ） was treated with neoadjuvant therapy （preoperative radiation with a total dosage of 50 Gy and synchronous 5-Fu-based chemotherapy） followed by radical tumor resection 4- 6 weeks after; the control group （n = 66） underwent primary surgery without neoadjuvant therapy. The clinical stage was evaluated before and after neoadjuvant therapy. The total lymph nodes yields, as well as the tumor-positive lymph nodes of each resected specimen was compared between the two groups statistically. Results Clinical downstage was achieved in 30 cases （56%） in study group after neoadjuvant therapy. The number of total lymph nodes and positive lymph nodes harvested from each resected specimen in the control group were 14 ± 7 and 2. 2 ± 3.7, meanwhile those were 9 ±6 and 0. 7 ±2.4 in study group, which were all significantly lower than those in control group （ P 〈 0. 01 ）. Conclusions Preoperative radiotherapy combined with chemotherapy can downstage the tumor and reduce the retrieval rate of total lymph nodes and positive lymph nodes in locally advanced rectal cancer. It is necessary to retrieve as many lymph nodes as possible for it has some prognostic significance for the patients.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第23期1779-1783,共5页
Chinese Journal of Surgery
关键词
直肠肿瘤
放射疗法
抗肿瘤联合化疗方案
淋巴结
Rectal carcinoma
Radiotherapy
Antineoplastic combined chemotherapy protocols
Lymph nodes
