摘要
目的 通过比较新辅助放化疗后cCR的直肠癌患者采用非手术治疗和TME治疗的效果,旨在探讨非手术治疗策略的可行性。方法 选取2006—2016年中山大学肿瘤防治中心接受术前放化疗并获得cCR的135例Ⅱ、Ⅲ期直肠癌患者,根据治疗方法的不同将其分为非手术组（43例NOM组）和标准手术组（92例SOM组）。比较2组患者的局部复发率、挽救性治疗后的累计LC率、DFS、OS以及保肛率等。Kaplan-Meier法计算LC、OS、DFS并Logrank法检验,χ2检验保肛率。结果 中位随访39个月（10~127个月）。135例患者的局部复发率及远处转移率分别为3.7%和11.1%,术后3年DFS和OS分别为90.5%和97.0%。NOM组与SOM组术后3、5年DFS率分别为87%与93%、73%与87%（P=0.089）,OS率分别为98%与99%、98%与97%（P=0.578）。NOM组局部复发5例（12%）,80%患者得到挽救性治疗,累计LC率为98%;SOM组无局部复发病例;两组差异有统计学意义（P=0.010）。NOM组保肛率为93%,显著高于SOM组的70%（P=0.030）。结论 新辅助放化疗后获得cCR的直肠癌患者采取非手术治疗策略是可行的,部分局部复发患者仍可通过及时的挽救性治疗痊愈,从而有效避免了TME及其并发症,提高了患者的生活质量。
Objective To investigate the feasibility of non-operative management （NOM） by comparing the therapeutic effects between NOM and total mesorectal excision （TME） for rectal cancer patients with clinical complete response （cCR） after neo-adjuvant chemoradiotherapy. Methods A total of 135 patients with stage Ⅱ/Ⅲ rectal cancer who obtained cCR after neo-adjuvant chemoradiotherapy in Sun Yat-sen University Cancer Center from 2006 to 2016 were recruited and assigned into the NOM （n=43） and standard operative management （SOM） groups （n=92）. The local recurrence rate,accumulative local control （LC） rate after salvage therapy,disease-free survival （DFS）,overall survival （OS） and sphincter preservation rate were statistically compared between two groups. Kaplan-Meier analysis and log-rank test were utilized to calculate the LC, OS and DFS.Chi-square test was performed to calculate the sphincter preservation rate. Results The mean follow-up duration was 39 months （range：10-127 months）.Of 135 patients, the local recurrence rate and distant metastasis rate were 3.7% and 11.1%,and the 3-year DFS and OS were 90.5% and 97.0%.In the NOM and SOM groups, the 3-year DFS were 87% and 93%, and the 5-year DFS were 73% and 87%（P=0.089）.The 3-year OS were 98% and 99%, and the 5-year OS were 98% and 97%（P=0.578）.In the NOM group, the local recurrence rate was 12%（n=5）,80% of patients received salvage treatment and the accumulative LC rate was calculated as 98%.In the SOM group, the local recurrence rate was 0, which was significantly lower than that in the NOM group （P=0.010）.In the NOM group, the sphincter preservation rate was 93%, significantly higher compared with 70% in the SOM group （P=0.030）. Conclusions It is feasible for rectal cancer patients with cCR to receive NOM following neo-adjuvant chemoradiotherapy. Partial locally recurrent patients can be healed by timely salvage therapy,thereby averting TME and relevant complications and enhancing the quality of life of
作者
张术
魏嘉旺
肖巍魏
王俏镟
常晖
曾智帆
丁培荣
陈功
潘志忠
高远红
Department of Radiation Oncology(Zhang S, Wei JW,Xiao WW, Wang QX, Chang H,Zeng ZF, Gao YH） , Department of Colorectal Surgery （ Ding PR, Chen G, Pan ZZ ） , Sun Yat-sen University Cancer Center, State Key laboratory of Oncology in South China, Guangzhou 510060, Chin)
出处
《中华放射肿瘤学杂志》
CSCD
北大核心
2018年第4期374-377,共4页
Chinese Journal of Radiation Oncology
关键词
直肠肿瘤
新辅助放化疗
临床完全缓解
随访观察
Rectal neoplasm
Neo-adjuvant chemoradiotherapy
Clinical complete response
Follow-up observation
