术后放化疗在高龄III期直肠癌患者中的临床应用价值

目的：研究术后放化疗在高龄（≥75岁）III期直肠癌患者中的临床应用价值。方法：回顾性分析2010年1月—2014年1月收治的128例高龄（≥75岁）III期直肠癌患者资料，根据术后是否进行放化疗将患者分为放化疗组（60例）和对照组（68例），比较两组无进展生存期、2年存活率、健康相关的生存质量和术后主要并发症。结果：与对照组比较，放化疗组患者无进展生存期明显延长[（793.58±295.39）d vs. （736.59±305.38）d，P=0.029]；2年存活率有增高趋势，但组间差异无统计学意义（91.7% vs. 79.4%，P=0.052）；术后 12个月时健康相关的生存质量评分明显增高（70.25 vs. 63.37，P<0.001）；局部复发率明显降低（16.7% vs. 33.8%，P=0.035）；放射相关性肠炎（13.3% vs. 0.0%）与骨髓抑制（11.7% vs. 0.0%）发生率明显增高（P=0.002，P=0.004）。两组患者肠瘘、肠梗阻和贫血发生率均无统计学差异（均P>0.05）。结论：术后放化疗虽然增加了术后并发症的发生率，但是显著改善了高龄III期直肠癌患者长期预后。

Clinical value of postoperative chemoradiotherapy in elderly patients with stage III rectal cancer

Objective: To investigate the application value of postoperative chemoradiotherapy in elderly patients with stage III rectal cancer. Methods: The clinical data of 128 consecutive elderly patients (≥75 years of age) with stage III rectal cancer treated from January 2010 to January 2014 were retrospectively analyzed. Patients were divided into chemoradiotherapy group (60 cases) and control group (68 cases) according to whether or not they received postoperative chemoradiotherapy. The progression-free survival, 2-year survival, health-related quality of life and postoperative complications between the two groups were compared. Results: In chemoradiotherapy group compared with control group, the progression-free survival was significantly prolonged [(793.58±295.39)d vs. (736.59±305.38)d, P=0.029], 2-year survival had an increasing tendency, but did not reach a statistical significance (91.7% vs. 79.4%, P=0.052), the score of higher health-related quality of life at 12 months after operation was significantly increased (70.25 vs. 63.37, P<0.001), the local recurrence rate was significantly reduced (16.7% vs. 33.8%, P=0.035), and the incidence of radiation enteritis (13.3% vs. 0.0%) and myelosuppression (11.7% vs. 0.0%) were significantly increased (P=0.002, P=0.004). There was no significant difference in incidence of intestinal fistula, intestinal obstruction and anemia between the two groups (all P>0.05). Conclusion: Though postoperative chemoradiotherapy increases the rate of postoperative complications, it can significantly improve the long-term outcomes in elderly patients with rectal cancer.