新辅助放化疗对直肠癌患者三年生存率和生存质量的影响分析

目的 探讨新辅助放化疗对局部进展期且可切除的直肠癌患者生存质量及肛门功能的影响.方法 四川省人民医院2015～2018年收治的中低位直肠癌患者,将术前分期为T3～4或N1～2且可切除的103例患者纳入研究,按是否行新辅助放化疗分为新辅助组53例和手术组50例.新辅助组化疗方案为FOLFOX、XELOX或单药口服,放疗方...

The effect of neo-adjuvant chemoradiotherapy on three-year survival rate and quality of life in patients with rectal cancer

Objective To investigate the effect of neo-adjuvant chemoradiotherapy on the quality of life and anal function of patients with locally advanced and resectable rectal cancer.Methods A total of 103 patients with middle and low rectal cancer admitted to our hospital from 2015 to 2018 were retrospectively analyzed.The patients with preoperative stage T3~4 or N1~2 and resectable were included in the study.In the neo-adjuvant group,53 patients were treated with FOLFOX,XELOX or single drug orally.The radiotherapy regimen was 5000cgy/25F.The operation was completed after 8~10 weeks of neo-adjuvant chemoradiotherapy.In the operation group,50 patients were operated within 4 weeks after diagnosis.The survival rate,quality of life,frequency of anal defecation and defecation control ability of the two groups were compared.Results The follow-up time was up to May 31,2020,and the median follow-up time was 26 months.The 3-year overall survival rate(OS)was 75.0%in the neo-adjuvant group and 74.0%in the operation group(P=0.912).The 3-year tumor free survival rate(DFS)was 60.5%in the neo-adjuvant group and 69.9%in the operation group(P=0.285).For further subgroup analysis,which was designed according to whether there is lymph node metastasis in the preoperative imaging,the 3-year OS of N0 patients in the neo-adjuvant group and the surgical group was 88.6%and 87.4%,respectively(P=0.944),and the 3-year OS of N+patients in the neo-adjuvant and surgical groups was 59.7%and 65.3%,respectively(P=0.804).The quality of life,frequency of defecation and defecation control ability of the neo-adjuvant chemoradiotherapy group were lower than those of the operation group(P=0.020,0.002 and 0.006,respectively).There was no significant difference in anal distension and anal pain between the two groups(P>0.05).Conclusion For patients with locally advanced rectal cancer whose primary lesion can be resected at R0,neo-adjuvant chemoradiotherapy does not significantly improve the survival rate when compared with that of direct operation.Neo-adjuvant chemoradiotherapy even has a worse effect on quality of life,postoperative anal defecation frequency and defecation control ability when compared to direct operation.