中国实用外科杂志

中国实用外科杂志

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新辅助放化疗治疗局部进展期直肠癌疗效分析

李干斌，韩加刚，王振军，魏广辉，渠    浩，翟志伟，易秉强，马华崇，杨    勇，王建良，李竹林   

  1. 首都医科大学附属北京朝阳医院普通外科，北京 100020
  • 出版日期:2021-02-01 发布日期:2021-02-05

  • Online:2021-02-01 Published:2021-02-05

摘要： 目的    探讨新辅助放化疗（nCRT）联合根治性手术治疗局部进展期直肠癌的安全性和疗效。方法    回顾性分析首都医科大学附属北京朝阳医院普通外科2013年3月至2018年12月收治的208例局部进展期直肠癌病人的临床资料。分为nCRT组（97例）和直接手术组（111例）。比较两组手术资料、围手术期并发症和局部复发率以及生存情况。结果    nCRT组肿瘤下缘与肛缘距离显著低于直接手术组［（5.8±2.2）cm vs. （6.9±2.9）cm，P=0.003］。nCRT组的病理完全缓解率(pCR)为19.6%，淋巴结清扫数量［（12.0±4.7）枚 vs. （16.6±6.7）枚，P＜0.001］、脉管浸润率（16.5% vs. 30.6%，P=0.017）和癌结节检出率（4.1% vs. 11.7%，P=0.046）均显著低于直接手术组。与直接手术组相比，nCRT组手术时间明显延长［（251.9±70.6 ）min vs.（227.4±85.0）min，P=0.015］、术中失血量显著增加（165 mL vs. 125 mL，P=0.041）、保护性造口率明显增加（85.1% vs. 28.0%，P＜0.001）。两组的保肛率、围手术期并发症总发生率、术后平均住院时间、造口还纳率等差异无统计学意义。随访时间34（6~83）个月，随访率91.4%。nCRT组的局部复发率明显降低（5.5% vs. 15.2%，P =0.03），5年总体生存率（OS）（77.4% vs. 59.5%，P =0.047）和无病生存率（DFS）（75.1% vs. 61.6%，P =0.015）显著升高。nCRT组中pCR病人的5年OS显著高于非pCR病人（100.0% vs. 69.3%，P=0.033）。结论    虽然nCRT显著增加了直肠癌病人的保护性造口率、延长手术时间和增加术中出血量，但能够明显降低肿瘤的局部复发率，增加病人5年OS和DFS。

关键词: 新辅助放化疗, 局部进展期直肠癌, 疗效分析, 生存预后

Abstract: Efficacy of neoadjuvant chemoradiotherapy for locally advanced rectal cancer: A retrospective study   LI Gan-bin, HAN Jia-gang, WANG Zhen-jun, et al. Department of General Surgery, Beijing Chaoyang Hosptial, Capital Medical University, Beijing 100020, China
Corresponding authors: HAN Jia-gang, E-mail: hjg211@163.com; WANG Zhen-jun, E-mail: wang3zj@sohu.com
Abstract    Objective    To evaluate the efficacy and safety of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) for the treatment of locally advanced rectal cancer. Methods    The clinical characteristics of locally advanced rectal cancer patients admitted in Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from March 2013 to December 2018 were analyzed retrospectively. Patients treated with nCRT followed by TME （97 cases）or surgery alone （111 cases） were divided into two groups to further discuss whether there exists a significant difference in postoperative complications, local recurrence and overall survival between the two groups. Results    The distance to the anal verge in nCRT group was significantly lower than that in surgery-alone group ［(5.8±2.2)cm vs. (6.9±2.9)cm, P=0.003］. Compared to surgery-alone group, the number of harvested lymph nodes ［(12.0±4.7) vs. (16.6±6.7), P＜0.001］, the rate of lymphovascular invasion (16.5% vs. 30.6%, P=0.017) and tumor deposit (1.7% vs. 14.1%, P=0.046) were significantly lower in nCRT group. The operation time ［(251.9±70.6) min vs. (227.4±85.0)min, P=0.015］, blood loss (165mL vs. 125mL, P=0.041) and protective stoma rate (85.1% vs. 28.0%, P＜0.001) were obviously higher than those in surgery-alone group. No statistical difference existed in sphincter-sparing rate and post-operative complications between the two groups. The mean follow-up time was 34 (6—83) months. The rate of local recurrence was significantly reduced in nCRT group (5.5% vs. 15.2%, P=0.03). The 5-year overall survival rate (OS) (77.4% vs. 59.5%, P=0.047) and 5-year disease-free survival rate (DFS) (75.1% vs. 61.6%, P=0.015) were obviously improved compared to surgery-alone. The 5-year OS of pCR in nCRT group was improved compared with that of  non-pCR （100.0% vs. 69.3%，P=0.033）. Conclusion    nCRT can reduce the rate of local recurrence with improved the 5-year OS and DFS significantly. However, it also results in prolonged operation time, increased intraoperative blood loss and rate of protective stoma.

Key words: neoadjuvant chemoradiotherapy, locally advanced rectal cancer, efficacy and safety, survival outcomes