直肠癌术后IMRT±化疗疗效及预后分析

目的 探讨直肠癌术后IMRT±化疗的疗效及预后影响因素。方法 回顾分析2009—2013年间218例直肠癌术后IMRT患者的临床资料。共208例(95.4%)患者进行了化疗, 方案以氟尿嘧啶为主。采用Kaplan-Meier法计算生存率, Logrank检验和单因素预后分析, Cox模型多因素预后分析。结果 随访率97.7%。1、3年OS率分别为90.8%、75.2%, DFS率分别为85.3%、70.5%, LRFS率分别为96.7%、88.1%。全组3—4级急性不良反应发生率为28.4%, 主要表现为3级白细胞减少(13.8%)和腹泻(11.0%)。单因素预后分析表明术前CEA、CA199水平、肿瘤最大径、肿瘤部位、分化程度、肿瘤浸润深度、淋巴结转移数、TNM分期、神经侵犯、手术方式、TME、术前肠梗阻和术前贫血为影响因素(P=0.006、0.000、0.000、0.017、0.000、0.016、0.000、0.011、0.001、0.001、0.006、0.037和0.010);多因素预后分析显示术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为影响因素(P=0.000、0.000、0.000、0.001和0.001)。结论 直肠癌术后IMRT±化疗疗效肯定, 不良反应轻, 治疗依从性较高。术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为预后影响因素。

Analysis of efficacy and prognostic factors of postoperative intensity-modulated radiotherapy with or without chemotherapy in rectal cancer

Objective To explore the efficacy and prognostic factors of postoperative intensity-modulated radiotherapy (IMRT) with or without chemotherapy in rectal cancer. Methods A retrospective analysis was performed on the clinical data of 218 patients with rectal cancer, who underwent postoperative IMRT in our hospital from January 2009 to December 2013.The Kaplan-Meier method was used to calculate survival rate;the log-rank test was used for survival difference analysis and univariate prognostic analysis;the Cox regression model was used for multivariate prognostic analysis. Results The follow-up rate was 97.7%. The 1-and 3-year overall survival rates were 90.8% and 75.2%, respectively, the 1-and 3-year disease-free survival rates were 85.3% and 70.5%, respectively, and the 1-and 3-year locoregional recurrence-free survival rates were 96.7% and 88.1%, respectively. The incidence of grade 3-4 acute adverse reactions was 28.4%, mainly manifested as leukopenia (13.8%) and diarrhea (11.0%). Univariate prognostic analysis showed that preoperative carcinoembryonic antigen (CEA) and CA199 levels, maximum tumor diameter, tumor location, degree of differentiation, depth of tumor invasion, number of lymph node metastases, TNM stage, perineural invasion, surgical procedure, total mesorectal excision, preoperative bowel obstruction, and preoperative anemia were the predictors of survival (P=0.006, 0.000, 0.000, 0.017, 0.000, 0.016, 0.000, 0.011, 0.001, 0.006, 0.037 and 0.010). Multivariate prognostic analysis showed that preoperative CEA level, tumor location, TNM stage, preoperative bowel obstruction, and preoperative anemia were the predictors of survival (P=0.000, 0.000, 0.000, 0.001 and 0.001). Conclusions Postoperative IMRT with or without chemotherapy is an effective method for rectal cancer with mild adverse reactions and high compliance. Preoperative CEA level, tumor position, TNM stage, preoperative bowel obstruction, and preoperative anemia are independent prognostic factors for the overall survival.