中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (07): 810-815.DOI: 10.19538/j.cjps.issn1005-2208.2024.07.18

• 论著 • 上一篇    下一篇

置入可扩张金属支架联合新辅助化疗治疗完全梗阻性左半结肠癌5年预后分析

石    阳a，翟志伟a，于剑锋b，曹    可a，叶春祥a，武云龙a，姚健楠c，马连港a，李竹林a，渠    浩a，王振军a，韩加刚a   

  1. 首都医科大学附属北京朝阳医院 a.普外科  b.消化内科  c.肿瘤内科，北京 100020
  • 出版日期:2024-07-01 发布日期:2024-07-21

  • Online:2024-07-01 Published:2024-07-21

摘要： 目的    探讨可扩张金属支架置入联合新辅助化疗后择期手术治疗完全梗阻性左半结肠癌的远期（5年）疗效。方法    回顾性分析2014年1月至2023年 5月首都医科大学附属北京朝阳医院普外科收治的82例完全梗阻性左半结肠癌病人的临床资料。按治疗方案分组：（1）支架组（35例）。先放置支架解除急性梗阻，再择期行根治性手术，即支架-手术策略。（2）支架-新辅助组（47例）。先放置支架解除急性梗阻，在等待期间给予新辅助化疗，再行根治性手术，即支架-新辅助化疗-手术策略。主要观察结局指标是总体生存率（OS）和无病生存率（DFS）。结果  所有病人均获随访，中位随访时间为55（12~112）个月。与支架组比较，支架-新辅助组的腹腔镜手术比例增加（89.4% vs. 65.7%，P=0.007），造口率降低（10.6% vs. 28.6%，P=0.038），检出淋巴结数增加［（30.3±16.0）枚vs. （23.0±10.0）枚，P=0.021］，但阳性淋巴结检出数差异无统计学意义［0（0~2.0）枚 vs. 0.5（0~3.0）枚，P=0.513］。支架-新辅助组病人的3年OS（85.2% vs. 60.0%，P=0.035）、3年DFS（81.5% vs. 50.0%，P=0.013）、5年OS（78.3% vs. 51.7%，P=0.048）和5年DFS（73.9% vs. 41.4%，P=0.019）均明显高于支架组；且5年局部复发率（2.1% vs. 14.3%，P=0.037）与远处转移发生率（12.8% vs. 34.3%，P=0.020）均低于支架组。Cox回归分析结果示，置入支架后的治疗方式（支架-手术策略）是影响梗阻性左半结肠癌病人OS（HR=2.42，95%CI 1.07-5.49，P=0.034）和DFS（HR=3.17，95%CI 1.30-7.76，P=0.011）的独立危险因素。结论    支架-新辅助化疗-手术策略可明显提高梗阻性左半结肠癌病人远期生存率，降低术后局部复发与远处转移风险。

关键词: 可扩张金属支架, 新辅助化疗, 完全梗阻性左半结肠癌, 长期疗效

Abstract: To investigate the long-term efficacy of self-expanding metallic stents (SEMS) combined with neoadjuvant chemotherapy in the treatment of completely obstructive left-sided colon cancer. Methods    A retrospective analysis was conducted based on the clinical data of 82 patients with completely obstructive left-sided colon cancer treated at the Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University between January 2014 and May 2023. Based on the treatment regimen, the patients were divided into two groups. Stent-Surgery Group (Stent Group, n=35): patients received SEMS to relieve acute obstruction followed by curative surgery after stabilization. Stent-Neoadjuvant Chemotherapy-Surgery Group (Stent-Neoadjuvant Group, n=47): patients received SEMS to relieve acute obstruction followed by neoadjuvant chemotherapy during waiting period and then curative surgery. The primary outcome measures were overall survival (OS) and disease-free survival (DFS). Results    All patients were followed up, with a median follow-up time of 55 months (range 12-112 months). Compared with the Stent Group, the Stent-Neoadjuvant Group had a significantly higher proportion of laparoscopic surgeries (89.4% vs. 65.7%, P=0.007), a significantly lower stoma rate (10.6% vs. 28.6%, P=0.038), an increase in the number of lymph nodes detected (30.3±16.0 vs. 23.0±10.0, P=0.021), while there was no significant difference in the number of positive lymph nodes detected between groups (0 ［0-2.0］ vs. 0.5 ［0-3.0］, P=0.513). The 3-year OS (85.2% vs. 60.0%, P=0.035), 3-year DFS (81.5% vs. 50.0%, P=0.013), 5-year OS (78.3% vs. 51.7%, P=0.048), and 5-year DFS (73.9% vs. 41.4%, P=0.019) in the Stent-Neoadjuvant Group were all significantly better than that in the Stent Group. The 5-year local recurrence rate (2.1% vs. 14.3%, P=0.037) and distant metastasis rate (12.8% vs. 34.3%, P=0.020) in the Stent-Neoadjuvant Group were significantly lower than that in the Stent Group. Cox regression analysis indicated that the treatment approach (stent-surgery) was an independent risk factor affecting OS (HR=2.42, 95%CI 1.07-5.49, P=0.034) and DFS (HR=3.17, 95%CI 1.30-7.76, P=0.011) in patients with obstructive left-sided colon cancer. Conclusion    The combination of SEMS and neoadjuvant chemotherapy significantly improves the long-term survival of patients with obstructive left-sided colon cancer and reduces the risk of postoperative local recurrence and distant metastasis.

Key words: self-expanding metallic stents, neoadjuvant chemotherapy, completely obstructive left-sided colon cancer, long-term efficacy