pT3N0期直肠癌术后辅助放疗价值探讨

目的 探讨pT₃N₀期直肠癌根治性切除术后辅助放疗价值。方法 回顾分析2003-2010年期间本院诊断明确且行TME术的 125例pT₃N₀期直肠癌患者资料,所有患者均接受术后化疗,其中 40例接受术后放疗。Kaplan-Meier法计算生存率,Logrank法检验和单因素预后分析,Cox法多因素分析影响LR因素。结果 5年样本量为 35例,5年OS和DFS分别为 82.3%和72.4%,术后放化疗和化疗的 5年OS分别为72%和83%(P=0.911)。多因素分析送检淋巴结个数、肿瘤是否侵犯肠周脂肪是LR的影响因素(P=0.045、0.021)。低危组(无高危因素)和高危组(≥1个) LR率分别为2.5%和11.8%(P=0.060)。结论 对于无高危因素的pT₃N₀期直肠癌患者术后放疗未能改善OS、LR率,对该期患者术后常规放疗有待探讨。

Value of postoperative adjuvant radiotherapy for pT3N0 rectal cancer

Objective To evaluate the value of adjuvant radiotherapy after radical resection for pT₃N₀ rectal cancer. Methods The clinical data of 125 patients with pT₃N₀ rectal cancer who were diagnosed and given total mesorectal excision in our hospital from 2003 to 2010 were retrospectively analyzed. All patients received postoperative adjuvant chemotherapy, while 40 out of them received postoperative adjuvant radiotherapy in addition. Survival rates were estimated using the Kaplan-Meier method, and univariate prognostic analysis was performed using the log-rank test. Multivariate analysis of influencing factors for local recurrence (LR) rate was performed using the Cox regression model. Results The 5-year sample size was 35. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 82.3% and 72.4%, respectively. There was no significant difference in the 5-year OS rate between the postoperative chemoradiotherapy group and the postoperative chemotherapy group (72% vs. 83%, P=0.911). Multivariate analysis suggested that the number of lymph nodes and perirectal fat infiltration were independent prognostic factors for LR rate (P=0.045;P=0.021). There was no significant difference in LR rate between the low-risk group (no high-risk factors) and the high-risk group (the number of high-risk factors ≥1)(2.5% vs. 11.8%, P=0.060). Conclusions Postoperative radiotherapy cannot improve the OS and LR rates for pT₃N₀ rectal cancer without any high-risk factors. The value of postoperative adjuvant radiotherapy for pT₃N₀ rectal cancer needs further evaluation.