直肠癌术前放化疗反应的相关因素分析

目的分析与进展期直肠癌术前放化疗反应相关的临床因素。方法回顾性分析我院2005年1月至2012年12月期间107例接受术前放化疗后行根治性手术的直肠癌患者的临床资料，分析对直肠癌术前放化疗反应的影响因素。结果单因素分析结果显示，年龄、性别、肿瘤距肛缘距离、肿瘤分化程度、肿瘤浸润深度、治疗前CA19-9水平与直肠癌患者对术前放化疗反应无关（P〉0．05），而肿瘤周径、肿瘤活动度、淋巴结转移、治疗前癌胚抗原（CEA）和血红蛋白水平与直肠癌患者对术前放化疗反应有关（P〈0．05）。进一步logistic回归分析结果显示，肿瘤活动度（P=-0．015）、治疗前CEA水平（P=O．012）和治疗前血红蛋白水平（P=0．007）是影响直肠癌患者对术前放化疗反应的独立危险因素，即直肠癌固定、治疗前CEA水平〉5．0μg／L及治疗前血红蛋白水平≤10g／L的直肠癌患者对术前放化疗反应差。结论通过对直肠癌术前放化疗影响因素的分析，可预测对放化疗的反应，指导临床进行个体化治疗及相关临床干预。

Clinical Predictive Factors of Tumor Response after Preoperative Chemoradiotherapy in Rectal Cancer

Objective To analyze the clinical predictive factors of tumor pathological response to preoperative chemoradiotherapy for rectal cancer. Methods One hundred and seven patients treated with preoperative capecitabine and pelvic conformal radiotherapy and underwent total mesorectal excision from January 2005 to December 2012 in this hospital were analyzed retrospectively. Tumor response according to tumor regression grade was evaluated. The correlation of clinicopathologic factors with tumor response was analyzed by logistic regression analysis. Results The single factor analysis results showed that the age, gender, distance of tumor from anal verge, differentiation degree of tumor, infiltration depth of tumor, and pretreatment CA19-9 level were not correlated with rectal cancer pathological response to preoperative chemoradiotherapy （P〉 0. 05）. The tumor circumferential extent, tumor mobilit, lymph node metastasis, pretreatment carcinoembryonic antigen （CEA） level, and pretreatment hemoglobin level were correlated with it （P〈 0. 05）. The logistic regression analysis results showed that non-fixed tumor （P=0. 015）, pretreatment CEA level ≤5.0 μg/L （P=0. 012）, and pretreatment hemoglobin level 〉 10 g/L （P=-0. 007） independently predicted a good pathologic response rate. Conclusion Tumor mobility, pretreatment CEA level, and hemoglobin level are important predictors of pathological response to preoperative chemoradiotherapy in rectal cancer.