241例局部晚期中低位直肠癌术前同步放化疗联合TME根治术长期疗效分析

目的 回顾性分析 241例局部晚期中低位直肠癌行术前同步放化疗联合TME根治性手术的长期疗效以及影响预后因素。方法 2006—2014年中国医学科学院北京协和医学院肿瘤国家癌症中心连续收治经盆腔MRI或腹盆CT确诊的局部晚期中低位直肠腺癌患者 241例进行分析,该组患者术前盆腔放疗剂量 42.0~50.4 Gy (中位数50 Gy),同步化疗采用卡培他滨 ±奥沙利铂,于同步放化疗后 4~15周(中位数7周)接受TME原则的根治性手术(R0切除),术后均建议行辅助化疗,但需考虑患者恢复情况及意愿。Kaplan-Meier法计算DFS、LRR、DM及OS并Logrank法检验,Cox模型多因素分析。结果 全组患者中位随访42个月,3年LRR、DFS、OS和DM分别为3.8%、76.2%、85.9%和20.6%。亚组分析发现ypT0-2、ypN阴性、pCR、TRG4级患者可以获得更高的DFS (ypT0-2∶ypT3-4:86.0%∶69.3%,P=0.002;ypN阴性∶ypN阳性:88.1%∶56.9%,P=0.000;pCR∶非pCR:100%∶72.4%,P=0.001;TRG4级∶TRG2-3级∶TGR0-1级:94.9%∶73.6%∶66.3%,P=0.011),多因素分析结果显示术后ypN状态是影响DFS的因素(P=0.000)。结论 局部晚期中低位直肠癌行术前同步放化疗联合根治性手术局部区域控制较理想,远处转移是治疗失败的主要原因,放化疗后ypN状态是影响DFS的独立预后因素。     

新辅助治疗评分预测临床Ⅲ期中低位直肠癌预后研究

目的 探讨临床Ⅲ期中低位直肠癌经术前同步放化疗后降期以及新辅助治疗评分(NAR)对预后的影响。方法 分析2006—2014年间本中心收治的经盆腔核磁或腹盆CT确诊的cⅢ期中低位直肠癌195例患者,术前放疗42.0~50.4 Gy (中位数50 Gy,93.8%患者放疗剂量≥50 Gy),卡培他滨±奥沙利铂同步化疗于同步放化疗后4—15周(中位数7周) TME手术(R0切除)。分析患者降期(yp0—Ⅱ期)及NAR评分(根据cT、ypT/N分期计算)对预后影响,应用Kaplan-Meier法计算3年DFS并Logrank法检验。结果 全组患者中位随访44个月(6.7~125.5个月),3年DFS为76.8%。术前同步放化疗后降期显著影响3年DFS (92.2%∶56.8%,P=0.000)。全组患者中位NAR评分15.0分(0~65.0分),其中评分低者3年DFS优于评分高者[≤15.0分(90.1%)∶>15.0分(57.0%),P=0.001];在降期患者中低NAR评分仍可获得更好的预后[≤8.4分(95.1%)∶>8.4分(87.5%),P=0.022]。结论 cⅢ期中低位直肠癌经术前同步放化疗后降期者预后相对较好,NAR评分可有效预测患者预后。     

术前同期放化疗治疗局部进展期中低位直肠癌疗效分析

目的 评价术前同期放化疗用于局部进展期中低位直肠癌的有效性和耐受性。方法 2007—2013年 共入组 51例 T₃、T₄期或N (+)的病理证实初治直肠癌患者。全盆腔三维放疗技术, 45.0~ 50.4 Gy分 25~ 28次;化疗采用FOLFOX4或XELOX方案,化疗在放疗开始第1、4周进行共2个周期;放化疗结束后 4~ 8周手术,术后1个月内开始行同方案巩固化疗。Kaplan-Meier 法计算生存率并 Logrank 检验和单因素分析及 Cox 模型行多因素预后分析。结果 49例 患者完成术前放化疗及手术治疗,中位随访时间2.9年 ,总保肛率为65%,总降期率为59%。pCR为20%。总≥3级不良反应发生率为25%,总并发症发生率为31%。3、5年 样本数分别为24、12例 ,3、5年 OS分别为81%、69%, DFS分别为76%、60%, LRFS分别为78%、70%,DMFS分别为82%、74%。多因素分析显示肿瘤降期为 5年 DFS、LRFS的独立预后因素。 结论 局部进展期中低位直肠癌术前放疗同期FOLFOX4或XELOX方案化疗能提高病理降期率和pCR率及保肛率,降期者可能有更好的生存优势。     

局部晚期直肠癌同步放化疗前后MRI参数与预后相关性研究

目的 探索局部晚期直肠癌术前同步放化疗前后MRI指标与预后关系。方法 回顾分析2015-2017年间在中国医学科学院肿瘤医院初治局部晚期直肠癌患者,具有放疗前、后MRI且接受手术且随访资料完整患者96例,均接受术前长程同步放化疗,放疗后6~13周接受根治性手术。对放化疗前4周内及之后4~8周的直肠MRI进行评价,并与3年无瘤生存(DFS)率进行相关分析。结果 全组患者T3、T4期者分别为80例(83%)、16例(17%),N0、N1-2期者分别为14例(15%)、82例(85%),直肠系膜筋膜受侵[MRF (+)]者69例(72%),肠壁外血管侵犯[EMVI (+)]者58例(60%)。全组患者接受术前放疗中位剂量为50Gy,均接受同步化疗增敏。同步放化疗后T分期降期率及N分期转阴率分别为24%和50%,MRF (+)率、EMVI (+)率分别降至37%(P<0.001)和27%(P<0.001)。单因素及多因素分析均显示放化疗后MRI显示N分期、EMVI状态转变与患者3年DFS相关(P<0.05)。结论 同步放化疗后MRI显示EMVI持续阳性、N1-N2期是DFS预后不良因素,提示改进治疗的必要性。     

局部进展期低位直肠癌新辅助放化疗初步临床观察

目的 探讨局部进展期低位直肠癌新辅助放化疗疗效。方法 回顾分析2014-2018年间入组的46例局部进展期低位直肠癌患者,肿瘤下缘距肛缘6cm内。术前放疗采用SIB-IMRT技术,直肠肿瘤及阳性淋巴结照射58.75Gy分25次(2.35 Gy/次),盆腔淋巴引流区照射50Gy分25次(2.0 Gy/次),同步口服卡培他滨进行化疗。放化疗结束后间隔6~12周行直肠癌根治术。Kaplan-Meier法计算总生存(OS)、无瘤生存(DFS)、无进展生存(PFS),无局部复发生存(LRFS)、无转移生存(MFS)。单因素分析用log-rank法检验,多因素分析用Cox回归模型。结果 中位随访时间为47个月,局部复发3例,远处转移6例,ypCR率为26%(12/46),保肛手术率为74%(34/46),R0切除率为100%(44/44),TN总降期率为87%(40/46),术后并发症发生率为13%(6/46)。3年OS、DFS、PFS分别为93%、91%、87%。单因素分析显示ypN分期是影响OS、DFS、PFS、LRFS、MFS的重要因素(均P<0.05),多因素分析显示ypN分期与DFS、PFS、LRFS、MFS均显著相关(均P<0.05)。 结论 局部进展期低位直肠癌患者行术前SIB-IMRT 58.75 Gy分25次联合卡培他滨化疗方案安全可行,提高了ypCR率及生活质量,不良反应可耐受,长期生存是否获益有待进一步深入研究。     

AJCC-TRG联合ypTN分期评价局部进展期直肠癌预后

目的 探讨AJCC-TRG分级联合ypTN分期评估局部进展期直肠癌(LARC)新辅助放化疗后的预后,并筛查预后最差的亚组人群。方法 2004—2012年间中山大学肿瘤防治中心收治LARC 263例,男176例,女87例,中位年龄55岁。所有患者接受术前新辅助放化疗,并于放疗结束后6~8周施行全直肠系膜切除术。根据第7版AJCC-TRG分级标准及ypTNM分期标准对术后组织标本重新评价。生存分析评价不同肿瘤退缩分级(TRG)联合ypTN对各项生存指标的预测情况。Kaplan-Meier法计算OS、DFS、LRFS及DMFS,Logrank法检验和单因素预后分析。结果 中位随访时间为60.1个月,全组5年OS、DFS、LRFS和DMFS分别为80.0%、75.0%、97.0%和81.0%。不同ypT/TRG、ypN/TRG组合间的OS、DFS及DMFS差异均有统计学意义(P均<0.05)。ypT₃—T₄/TRG 2—3、ypN₁—N₂/TRG 2—3亚组预后最差,5年OS,DFS和DMFS分别为66.9%、56.0%,52.2%、41.4%和60.9%、46.0%。结论 AJCC-TRG联合ypTN分期能更准确评估LARC预后,筛查出高危远处转移预后最差亚组人群,对指导LARC个体化术后辅助治疗具有重要临床意义。     

Ⅰ—Ⅱ期韦氏环弥漫大B细胞淋巴瘤化疗后辅助放疗价值探讨

目的 探讨Ⅰ—Ⅱ期韦氏环弥漫大B细胞淋巴瘤(WR-DLBCL)患者化疗达CR后接受辅助放疗对预后的影响。方法 收集2005—2013年间浙江省肿瘤医院收治的130例Ⅰ—Ⅱ期WR-DLBCL资料,全部接受至少2个周期CHOP或R-CHOP化疗并达CR。R-CHOP组43例(含放疗25例),CHOP组87例(含放疗76例)。29例接受了单纯化疗,101例接受了放化疗。Kaplan-Meier法计算生存率并Logrank法检验和单因素预后分析,Cox模型多因素预后分析。结果 5年样本量为101例。单因素分析显示ECOG评分0、1分的5年OS率分别为95.6%、80.1%(P=0.000),5年DFS率分别为95.7%、75.4%(P=0.029);单纯化疗、放化疗的5年OS率分别为77.1%、91.7%(P=0.048),5年DFS率分别为77%、87.4%(P=0.037)。Cox模型多因素分析显示ECOG评分均是OS、DFS影响因素(P=0.047、0.003),加用放疗对DFS获益有关(P=0.039),但与OS无关(P=0.133)。结论 疗前ECOG评分低的Ⅰ—Ⅱ期WR-DLBCL患者预后较好,对化疗后获CR者加用辅助放疗可能获益,但需进一步开展前瞻性随机对照研究证实。     

LncRNA-SChLAP1在结直肠癌组织中高表达的预后评估意义

目的 探讨长链非编码RNA-SChLAP1过表达对结直肠癌(CRC)预后的影响。方法 选取符合严格随访标准的156例CRC患者和 43例癌旁结直肠组织进行qRT-PCR检测,评估SChLAP1表达与CRC临床病理特征和总生存期(OS)、无病生存期(DFS)的关系,以及影响CRC患者OS和DFS的风险因素。结果 CRC中SChLAP1水平明显高于癌旁结直肠组织,差异有统计学意义(P＜ 0.01)。SChLAP1高表达与CRC的分化和分期有关,也与DFS和OS有关(P＜ 0.01)。Cox比例风险回归模型发现SChLAP1表达是CRC患者OS和DFS下降的独立风险因素。结论 SChLAP1在CRC进展中起着重要作用,SChLAP1 可能作为独立的生物标志物用于CRC的预后评估。     

乳腺癌新辅助化疗后改良根治术后放疗开始时间对预后的影响

目的 本研究旨在分析接受新辅助化疗的局部晚期乳腺癌患者改良根治手术时间到放疗开始时间(SRI)对患者预后的影响。方法 回顾性分析全国11家肿瘤中心的1087例接受新辅助化疗和改良根治术后放疗的乳腺癌患者。用Maxstat方法寻找手术到放疗间隔时间对预后影响的最佳界值。采用Cox多因素回归和倾向配比评分(PSM)分析手术距放疗间隔时间对预后的影响。结果 全组中位随访72.9个月,5年无瘤生存(DFS)率和总生存(OS)率分别为68.1%和81.8%。全组患者分为SRI≤18周(917例)和 SRI>18周(170例)两组。多因素分析显示激素受体状态、病理T分期、病理N分期和SRI是DFS影响因素(P<0.001、<0.001、<0.001、0.023)。激素受体状态、病理T分期、病理N分期、内分泌治疗和SRI是OS影响因素(P=0.013、0.006、<0.001、0.013、0.001)。采用PSM均衡两组患者临床病理因素后SRI≤18周患者DFS和OS仍然优于SRI>18周者。结论 新辅助化疗后乳腺癌患者改良根治手术到放疗间隔时间影响预后,患者应尽量在手术后18周内开始放疗。     

胸段食管鳞癌根治术后淋巴结阳性患者不同治疗方式比较

目的 比较胸段食管鳞癌(TESCC)根治术后淋巴结阳性患者不同治疗方式的疗效,探讨其最佳治疗模式。方法 回顾性分析2007—2010年间 548例TESCC根治术后淋巴结阳性患者,分析其不同治疗方式的疗效情况,并应用倾向得分匹配(PSM)对不同治疗方式组患者进行1∶1配比,进一步分析并明确适合患者的最佳治疗模式。Kaplan-Meier法计算生存率,Logrank法单因素预后分析,Cox模型行多因素预后分析。结果 1、3、5年OS分别为79.9%、38.1%、28.5%,DFS分别为68.5%、39.8%、32.5%。经PSM配比后单纯手术、PORT、POCT和POCRT组患者均有可比性,1、3、5年OS和DFS差异均有统计学意义(P均=0.000)。N1、N2和N3期患者OS和DFS差异亦均有统计学意义(P均=0.000)。多因素分析显示治疗方式和N分期均为影响患者OS和DFS的影响因素(P=0.001、0.000和0.025、0.016)。结论 TESCC根治术后淋巴结阳性者预后较差且淋巴结转移数目越多则预后越差,行术后放化疗可能会提高患者生存。     

Preliminary clinical observation of neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer

Objective To evaluate the efficacy of preoperative neoadjuvant chemoradiotherapy for low and locally advanced rectal cancer. Methods Clinical data of 46 patients with low rectal tumors located within 6 cm from the edge of anal admitted to our hospital between February 2014 and December 2018 were retrospectively analyzed. SIB-IMRT technique was adopted for preoperative radiotherapy. Rectal tumors and positive lymph nodes were irradiated with a dose of 58.75 Gy in 25 fractions (2.35 Gy/fraction), and pelvic lymphatic drainage area was given with 50 Gy in 25 fractions (2.0 Gy/fraction). Oral administration of capecitabine was delivered for concurrent chemotherapy. Radical surgery for rectal cancer was performed at 6 to 12 weeks after the end of chemoradiotherapy. The overall survival (OS), disease-free survival (DFS), progression-free survival (PFS), local recurrence-free survival (LRFS) and metastasis-free survival (MFS) were calculated by using Kaplan-Meier method. Univariate analysis was conducted by log-rank test, and multivariate analysis was performed by Cox’s regression model. Results After a median follow-up of 47 months, local recurrence occurred in 3 patients and distant metastasis in 6 patients. The ypCR rate was 26%(12/46), the sphincter-preservation rate was 74%(34/46), the R0 resection rate was 100%(44/44), the overall tumor response TN down staging rate was 87%(40/46), and the postoperative complication rate was 13%(6/46). The 3-year OS, DFS, and PFS were 93%,91% and 87%, respectively. In univariate analysis, ypN staging was an important factor affecting OS, DFS, PFS, LRFS and MFS (all P<0.05). In multivariate analysis, ypN staging was significantly correlated with DFS, PFS, LRFS and MFS (all P<0.05). Conclusions Preoperative SIB-IMRT 58.75 Gy in 25 fractions combined with capecitabine chemotherapy is a safe and efficacious treatment for patients with low and locally advanced rectal cancer, which improves the ypCR rate and quality of life, and yields tolerable adverse reactions. Nevertheless, the long-term survival benefits remain to be validated.     

Usefulness of Restaging Pelvis Magnetic Resonance Imaging After Neoadjuvant Concurrent Chemoradiotherapy in Patients With Locally Advanced Rectal Cancer

IntroductionIn patients with locally advanced rectal cancer, restaging pelvis magnetic resonance imaging (MRI) after neoadjuvant concurrent chemoradiotherapy is recommended despite its limited accuracy in predicting pathologic T (ypT) and N (ypN) stage. Neoadjuvant rectal (NAR) score is a novel short-term surrogate endpoint for disease-free survival (DFS) and overall survival (OS). We tested the agreement between restaging MRI T (yT) and N (yN) with ypT and ypN stages, respectively, and explored the prognostic significance of restaging MRI NAR (mNAR) score.Patients and MethodsBetween 2014 and 2018, 43 patients with locally advanced rectal cancer completed neoadjuvant concurrent chemoradiotherapy, had a restaging MRI, and underwent surgery. Weighted kappa was used to test the agreement between yT and yN with ypT and ypN, respectively. A kappa value of less than 0.5 was deemed unacceptable. Paired t test was used to compare NAR and mNAR mean scores. Survival was estimated by Kaplan-Meier curves.ResultsRestaging MRI could not predict ypT stage (slight agreement, κ = 0.111) or ypN stage (fair agreement, κ = 0.278). The mean mNAR score was higher than the mean NAR score (20 vs. 16, P = .0079). The median DFS for patients with low-intermediate NAR and high NAR was not reached vs. 30 months (P = .0063). The median OS for patients with low-intermediate NAR and high NAR was not reached vs. 40 months (P = .0056). There was a trend for longer DFS and OS in patients with low-intermediate mNAR scores (not reached in both groups, P = .058) compared to patients with high mNAR scores (not reached in both groups, P = .15).ConclusionRestaging MRI could not predict ypT and ypN stage. The mean mNAR score was higher than the mean NAR score. There was a trend for longer DFS and OS in patients with low-intermediate mNAR scores compared to patients with high mNAR scores.     

Can the new American Joint Committee on Cancer staging system predict survival in rectal cancer patients treated with curative surgery following preoperative chemoradiotherapy?

BACKGROUND:

Although ypStage has been known as a strong prognosticator of recurrence and survival, the detailed interaction of ypT and ypN classification on a survival rate has never been evaluated.

METHODS:

Between October 2001 and December 2007, in total, 960 patients with locally advanced rectal cancer were enrolled retrospectively at 3 centers. Five‐year overall survival (OS) and disease‐free survival (DFS) rate were calculated for each ypTN classification.

RESULTS:

The ypT classification interacted with ypN classification to affect survival in most categories. Patients with ypStage 0 and I cancers showed a >90% 5‐year OS (ypStage 0, 96.5%; ypStage I, 92.9%; P = .346) and 5‐year DFS (ypStage 0, 90.2%; ypStage I, 90.7%; P = .879). Among ypStage III subgroups, large differences in 5‐year OS (ypStage IIIA, 90.1%; ypStage IIIB, 68.3%; ypStage IIIC, 40.5%; P < .001) and 5‐year DFS (ypStage IIIA, 74.8%; ypStage IIIB, 55.1%; ypStage IIIC, 12.3%; P < .001) were observed. OS and DFS in patients with ypStage IIIA disease were similar to or greater than those in patients with ypStage IIA or IIB/IIC disease. Four patient risk groups were defined: 1) low (ypT0‐isN0, ypT1N0, ypT2N0), 2) intermediate (ypT0‐2N1, ypT3N0), 3) moderately high (ypT0‐2N2, ypT3N1, ypT4N0), and 4) high risk (ypT3N2, ypT4N1‐2). Risk grouping showed a narrower range of survival rate compared with ypStage grouping.

CONCLUSIONS:

ypStage in rectal cancer, defined according to the 7th edition of the American Joint Committee on Cancer staging system, predicts survival for most ypNT classifications. However, patients with ypStage I rectal cancer have a similar prognosis to those with ypStage 0 cancer, and risk grouping reflects more precise survival outcomes than ypStage. Cancer 2012. © 2012 American Cancer Society.     

两种评分方法对局部晚期直肠癌同期放化疗+手术的预后预测价值比较

目的:比较新辅助直肠(NAR)评分和降期深度评分(DDS)对直肠癌新辅助同期放化疗后疗效的预测。方法:回顾分析2015—2018年间医科院肿瘤医院初治的局部晚期(T 3-T 4和/或N 1-N 2M 0期)、具有疗前MRI资料、接受术前长程同期放化疗(CRT)...     

低位直肠癌术前同步放化疗的远期疗效及安全性研究

目的评估术前口服卡培他滨（希罗达）与放疗联合治疗局部进展期低位直肠癌的远期疗效及安全性。方法对局部进展期（T3／T4）低位直肠腺癌（距肛缘≤9Ccm）患者51例,术前给予口服卡培他滨（希罗达）并联合放疗。放疗结束后休息3—4周,按TME原则进行手术。结果3例患者临床完全消退（cCR）,占5．88％,未行手术;其余48例患者均行根治性切除术（R0）,实际保肛率90．20％（46／51）,10例术后病理检查未见肿瘤细胞,为病理消退（pCR）,总消退率为25．49％（13／51）。肿瘤降期41例,占80．39％。5年无病生存率为70．59％,总生存率为80．39％。放化疗过程中出现3、4级不良反应5例,无疾病进展、手术死亡者。结论术前口服卡培他滨联合放疗治疗局部进展期低位直肠癌是有效安全的。