Ⅳ期直肠癌盆腔放疗疗效和预后因素分析

目的 回顾分析Ⅳ期直肠癌患者盆腔放疗疗效和预后因素。方法 2000—2010年接受盆腔放疗和(或)直肠手术的Ⅳ期直肠腺癌患者6l例,包括转移灶及原发灶均切除19例,转移灶未切除但原发灶切除19例,转移及原发灶均未切除但盆腔放疗23例。Kaplan-Meier法生存分析并Logrank法检验和单因素分析,分类资料间比较Fisher’s 精确概率法。结果 5年OS、PFS率分别为26%、17%。预后分析显示T₄期、N (+)、年龄>65岁、肝外转移、原发灶未切除与OS相关, T₄期、N (+)和与原发灶未切除与PFS相关。转移灶切除患者中直肠根治性切除后是否盆腔放疗的5年OS率分别为67%和32%(P=0.119),转移灶未切除患者中直肠原发灶是否切除的2年OS率分别为52%和27%(P=0.057)。直肠原发灶单纯盆腔放疗者中仅4例需要手术造瘘。结论 转移灶可切除Ⅳ期直肠癌术后盆腔放疗的价值有待研究。转移和原发均不可切除Ⅳ期直肠癌原发部位行盆腔放疗疗效确切。

An analysis of efficacy of pelvic radiotherapy and prognostic factors for stage IV rectal cancer

Objective To retrospectively analyze the efficacy of pelvic radiotherapy and prognostic factors for stage IV rectal cancer. Methods From 2000 to 2010, 61 patients with stage IV rectal cancer who received pelvic radiotherapy with or without rectal surgery were enrolled as subjects. In those patients, 19 had both primary and metastatic tumors resected, 19 had only primary tumor resected, and 23 received pelvic radiotherapy with both primary and metastatic tumors intact. The Kaplan-Meier method was used to estimate survival rates, and the log-rank test was used for survival difference analysis and univariate prognostic analysis. Comparison of disaggregated data was made by Fisher′s exact test. Results The 5-year overall survival (OS) and progression-free survival (PFS) rates in all patients were 26% and 17%, respectively. The prognostic analysis showed that stage T₄, positive node, age greater than 65 years, metastasis outside the liver, and intact primary tumor were prognostic factors for OS, while stage T₄, positive node, and intact primary tumor were prognostic factors for PFS. In patients with both primary and metastatic tumors resected, 5-year OS rates in patients treated with and without pelvic radiotherapy were 67% and 32%, respectively (P=0.119). In patients with intact metastatic tumor, 2-year OS rates in patients with resected and intact primary tumor were 52% and 27%, respectively (P=0.057). Only 4 patients who received pelvic radiotherapy alone for primary rectal tumor needed ostomy. Conclusions The value of postoperative pelvic radiotherapy still needs further studies in patients with stage IV rectal cancer and resectable metastatic tumor. Pelvic radiotherapy for primary tumor achieves definitive treatment outcomes in patients with stage IV rectal cancer and unresectable primary and metastatic tumors.