新辅助化疗对结直肠癌肝转移老年患者的效果及安全性

目的 探讨新辅助化疗对结直肠癌肝转移老年患者的有效性和安全性。方法 对2016年2月至2019年5月就诊于安徽省庐江县中医院（46例）和河南省人民医院（34例）的80例结直肠癌同时性肝转移老年患者的临床资料进行回顾性分析。对照组（n=40）行腹腔镜原发灶切除+肝转移灶同期/分期切除手术+术后XELOX方案化疗,观察组（n=40）在对照组基础上术前行XELOX方案新辅助化疗,术后随访12个月。结果 观察组新辅助化疗后原发灶的临床分期较化疗前明显好转（χ²=5.12,P=0.021）,肝转移灶直径缩小（6.4±3.8）cm vs （4.2±3.0）cm,t=2.74,P=0.008]。两组手术时间、排气时间比较,差异无统计学意义（P>0.05）,观察组术中出血量少于对照组（725.4±61.8）mL vs （842.6±167.1）mL,t=3.33,P=0.001],术后不良反应发生率高于对照组47.50%（19/40） vs 12.50%（5/40）,χ²=11.67,P<0.001];术后6个月KPS评分高于对照组（67.38±12.39）vs （51.03±10.55）,t=6.35,P<0.001];术后12个月肿瘤复发率低于对照组15.38%（6/39） vs 37.50%（15/40）,χ²=4.9,P=0.026],两组术后12个月病死率无统计学差异7.69%（3/39） vs12.5%（5/40）,P>0.05]。结论 新辅助化疗可提高结直肠癌肝转移老年患者客观缓解率,降低近期肿瘤复发率,改善患者术后功能状态,但会增加患者术后不良反应,能否在临床推广仍需进一步大样本研究。

Effect and safety of neoadjuvant chemotherapy in elderly colorectal cancer patients with liver metastasis

Objective To investigate the efficacy and safety of neoadjuvant chemotherapy in colorectal liver metastasis (CRLMs) in elderly patients. Methods A total of 80 elderly patients with CRLMs admitted to Lujiang County Hospital of Traditional Chinese Medicine (n=46) and Henan Provincial People's Hospital (n=34) from Feb. 2016 to May. 2019 were retrospectively analyzed. Patients in the control group (n=40) were treated with laparoscopic resection of the primary tumor and synchronous or stage liver metastasis followed by postoperative XELOX chemotherapy. On this basis, patients in the observation group (n=40) were treated with preoperative XELOX chemotherapy. All patients were followed up for 12 months after surgery. Results After neoadjuvant chemotherapy, the clinical stage of primary tumor and tumor diameter (6.4±3.8)cm vs (4.2±3.0)cm, χ²=5.12, P=0.021] were significantly improved in the observation group. No significant differences in operation time and exhaust time were found between the two groups (P>0.05). In the observation group, intraoperative blood loss was significantly less (725.4±61.8)mL vs (842.6±167.1)mL, t=3.33, P=0.001] while the incidence of adverse reactions was significantly higher 47.50%(19/40) vs 12.50%(5/40), χ²=11.67, P<0.001] compared to the control group. KPS score 6 months postoperation in observation group were significantly higher in the observation group than that in the control group (67.38±12.39) vs (51.03±10.55), t=6.35, P<0.001]. There was no significant difference in 12-month mortality between the two groups (P>0.05). 12-month tumor recurrence rate of observation group was lower than that in the control group 15.38%(6/39) vs 37.50%(15/40), χ²=4.9, P=0.026]. Conclusion Neoadjuvant chemotherapy therapy can improve the objective remission rate, reduce the short-term tumor recurrence rate and improve the postoperative functional status for elderly colorectal cancer patients with liver metastasis, but with the increase of adverse reactions. That further large sample study is needed to prove its clinical value.