中低位直肠癌新辅助放化疗后病理完全缓解预测因素分析

目的探讨预测中低位直肠癌新辅助放化疗后病理完全缓解(pCR)的临床因素。方法回顾性分析2013年1月至2016年10月中山大学附属第六医院收治的行新辅助放化疗联合全直肠系膜切除手术治疗的185例进展期中低位直肠癌病人的临床病理资料;包括年龄、治疗前癌胚抗原(CEA)、病理类型及分期、新辅助化疗方案、放疗结束至手术间隔时间等。根据肿瘤治疗反应分为pCR组(49例)和non-pCR组(136例);计算pCR率并分析其影响因素。结果术后49例(26.5%)病人达到pCR;103例病人病理学疗效分级为0或1;总降期率为55.8%。单因素分析显示;肿瘤T分期(P=0.004)和N分期(P=0.032)、治疗前CEA水平(P=0.039)、化疗方案(P=0.003)与pCR相关;多因素分析显示;T2分期和化疗方案中含有奥沙利铂是pCR的独立影响因素。结论 T2分期和以氟尿嘧啶为基础同时联合奥沙利铂的化疗方案是影响中低位直肠癌新辅助放化疗pCR的独立预测因素。

Clinical verification of sensitivity to neoadjuvant chemoradiotherapy in cases of locally advanced rectal cancer

Clinical verification of sensitivity to neoadjuvant chemoradiotherapy in cases of locally advanced rectal cancer HUANG Liang，CAI Yong-hua，ZHANG Xing-wei，et al. Department of Colorectal Surgery & Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases，the Sixth Affiliated Hospital，Sun Yat-sen University，Guangzhou 510655，China
Corresponding author：KANG Liang，E-mail: eonkang@163.com
Abstract Objective To identify the influencing factors of pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. Methods The clinical data of 185 locally advanced rectal cancer patients admitted at the Sixth Affiliated Hospital Sun Yat-sen University between January 2013 and October 2016 were analyzed retrospectively. Patients were divided into two groups according to their responses to neoadjuvant therapy: the pCR （49 patients）and non-pCR groups （136 patients）. The correlation between clinicopathological factors and PCR was analyzed. Results The rate of pathologic complete response (pCR) was 26.5%，and downstaging rate（ypStage 0 to 1） was achieved 55.8%. In univariate analyses，carcinoembryonic antigen concentration（P=0.039），clinical stage T（P=0.004），stage N（P=0.032）and neoadjuvant chemoradiotherapy with oxaliplatin（P=0.003） were significantly associated with pCR. In multivariate analysis，clinical stage T2 and neoadjuvant chemoradiotherapy with oxaliplatin were significantly associated with pCR，while CEA level was a marginally significant risk factor. Conclusion Stage T2 cancer and fluorouracil-based neoadjuvant chemoradiotherapy with oxaliplatin are independent clinical predictors for achieving pCR.