中低位进展期直肠癌患者新辅助化放疗后肿瘤分期及生物学特性的改变

目的探讨新辅助化放疗对中低位进展期直肠癌的疗效、肿瘤分期及生物学特性的影响。方法选择2009年2月至2012年2月间到山西省肿瘤医院肛门结直肠外科住院的部分中低位直肠癌患者57例。全部病例术前均经直肠指检、螺旋CT、盆腔MRJ、直肠腔内超声及肿瘤标志物等检查，证实为进展期直肠癌，并按AJCC标准进行TNM分期（Ⅱ期21例、Ⅲ期33例、Ⅳ期3例），术前接受了新辅助化放疗（化疗方案为FOLFOX6、放疗总剂量为40Gy，2Gy／次），化放疗结束后，遵循TME原则行手术治疗。结果（1）新辅助治疗后，Ⅱ期21例患者中3例降为ToNoM0，10例降为Ⅰ期；Ⅲ期33例患者中14例降为I期、11例降为Ⅱ期，Ⅳ期3例患者中1例降为Ⅲ期，总的降期率为68．4％；T分期38例（66．7％）下降；N分期25例（69．4％）下降，新辅助治疗后与治疗前比较，肿瘤明显降期，差异显著，分别为（z0=46．83，P〈0．001；X2=43．5，P〈0．001；X2=23．49，P〈0．001）。（2）新辅助治疗后57例患者CEA、CA19．9、CA242水平与治疗前比较明显下降，差异有统计学意义（P〈0．05，P〈0．001），CA724水平差异不显著（P〉0．05）。（3）新辅助治疗后局部肿瘤浸润及转移淋巴结有不同程度减轻；肿瘤平均直径由治疗前的4．3缩小为2．1cm。（4）2例患者因化放疗期间毒副作用而终止术前治疗，未进行手术。（5）保肛率为82．7％（43／52），且无一例发生围手术期死亡。结论术前经新辅助治疗对中低位进展期直肠癌患者肿瘤明显降期，肿瘤标志物水平降低，临床和病理缓解率增加，提高了肿瘤切除率和保肛率，改善患者的生活质量。

Impact for staging and biological characteristics ot the neoadjuvant chemoradiotherapy in advanced mid-lower rectal cancer patients

Objective To explore the effect of neoadjuvant chemoradiotherapy for advanced mid-low rectal cancer staging and biological characteristics. Methods Fifty-seven patients with advanced mid-tower rectal cancer were selected between Feb. 2009 and Feb. 2012 from the Shanxi tumor hospital. All of the patients were diagnosised advanced rectal cancer by tactus, CT, MR/, endo-luminal ultrasound and tumor marker. The TNM staged of the patients by AJCC standard （Stage Ⅱ 21 cases; Stage Ⅲ 33 cases; Stage Ⅳ 3 cases）. All selected patients received neoadjuvant chemoradiotherapy （Chemotherapy program was FOLFOX6, Radiotherapy total dose was 40 Gy, 2 Gy/time, 5 times/week）, after in 4-6 weeks TME was performed. Results The tumor stage assessment of the 57 cases who had completed the neoadjuvant therapy was as follows： Stage ToNoM0 3 cases; Stage Ⅰ 24 cases; Stage Ⅱ19 cases; Stage Ⅲ 11 cases. Tumor down-staging rate was 68.4% （39/57）; T down-staging occurred rate was 66.7% （38/57）; N down-staging rate was 69.4% （25/36）, tumor down staging were significant difference compared with before neoadjuvant therapy （X2= 46.83, P〈 0.001 ; X2= 43.5, P〈 0.001; X2=23.49, P〈0.001, respectively）. After neoadjuvant therapy in 57 patients with CEA, CA19-9, CA242 levels decreased significantly as compared with before therapy, there were significant differences, respectively （P〈0.05, P〈0.001）, the level of CA724 showed no significant difference （P〉0.05）, After neoadjuvant therapy, infiltration of local tumor and lmpyh node metastasis were obviously alleviated, the average diameter of the tumors was reduced from 4.3 before therapy to 2.1 cm. The anal preservation rate was 82.7% （43/52）, and no case died during peroperative period. Conclusion Preoperative neoadjuvant therapy for advanced mid-lower rectal cancer patients was significantly down staging, tumor marker levels decrease, clinical and pathological remission rate increase, improve the resection rate and the rate of anal preservation, improve the life quality of the patients.