摘要
目的探讨如何在新辅助治疗之前对局部进展期直肠癌患者、尤其是病理完全缓解（pCR）者进行疗效预测，以精准实施术前新辅助治疗。方法2000年1月至2011年1月期间，在中山大学肿瘤防治中心结直肠科确诊为局部进展期直肠癌并接受新辅助放化疗、且资料齐全的125例患者纳入研究。男85例，女40例；年龄15～77（平均数54）岁。全部患者均接受放疗46Gy／23次；同期接受XELOX方案化疗（奥沙利铂100mg／m^2，卡培他滨2000mg／m^2）2个疗程；均在放化疗后6～8周接受了根治性手术。回顾性分析这组病例资料，病理缓解情况分为4级，达到4级者为病理完全缓解（pCR）；2级以上表示对放化疗有较好的反应。采用Logistic回归模型来明确临床指标与pCR的关系。结果125例患者有16例（12．8％）达到了pCR，90例（72．0％）对放化疗有较好的反应。年龄（OR：1．060，P=0．037）和术前直肠超声淋巴结阳性（OR：0．059，P=0．006）是直肠癌新辅助治疗后能否达到pCR的独立影响因素。结论术前检查提示存在肠周淋巴结转移的患者放化疗效果较差。年龄与患者放化疗是否达到病理完全缓解有关。
Objective To explore the efficacy prediction of the locally advanced rectal cancer patients, especially those with pathological complete response （pCR）, receiving neoadjuvant chemoradiotherapy in order to execute precise preoperative neoadjuvant chemoradiotherapy. Methods From January 2000 to January 2011, 125 patients diagnosed as locally advanced rectal cancer receiving preoperative neoadjuvant ehemoradiotherapy in our department with complete data were enrolled in this study, including 85 males and 40 females with mean age of 54 （15 to 77） years old. All the patients received radiotherapy with 46 Gy （23 times） and administered XELOX regimen （oxaliplatin 100 mg/m2 plus capecitabine 2 000 mg/m2） for 2 courses simultaneously, and underwent radical operation 6 to 8 weeks after chemoradiotherapy. The data of these patients were analyzed retrospectively. Pathological remission was divided into 4 grades. Patients achieving grade 4 were defined as pCR, and those achieving above grade 2 were defined as better response. Logistic regression analysis was used to identify significant predictors of pCR. Results Among 125 patients, 16 （12.8%） achieved pCR status, and 90 （72.0%） had better response to the neoadjuvant chemoradiotherapy. Logistic regression analysis showed that age （OR：1.060, P = 0.037） and preoperative positive lymph nodes detected by endorectal uhrasonography （OR ：0.059, P = 0.006） were independent predictors of pCR after neoadjuvant chemoradiotherapy. Conclusions Preoperative existence of lymph node metastasis around bowel indicates the poor response to neoadjuvant chemoradiotherapy. Age is associated with pCR in patients receiving neoadjuvant chemoradiotherapy.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第6期664-667,共4页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金（81502459）
关键词
直肠肿瘤
新辅助放化疗
病理完全缓解
预测
Rectal neoplasms
Neoadjuvant chemoradiotherapy
Pathological completerespond
Predictor
