發(fā)布時(shí)間：2018-05-29 14:15

  本文選題：中低位進(jìn)展期直腸癌 + 新輔助放化療　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景和目的:新輔助放化療結(jié)合根治性手術(shù)已成為局部進(jìn)展期中低位直腸癌的標(biāo)準(zhǔn)治療方案。新輔助放化療可使腫瘤縮小、區(qū)域淋巴結(jié)降期、降低局部復(fù)發(fā)率。如何在術(shù)后精確評估患者遠(yuǎn)期預(yù)后是現(xiàn)階段的重要課題,同時(shí)不同病理類型的局部進(jìn)展期直腸癌新輔助放化療效果亦存在差異。本研究通過回顧性研究,探討局部進(jìn)展期中低位直腸癌患者新輔助放化療后行腹腔鏡直腸癌根治術(shù)效果及其臨床意義。方法:本研究回顧性收集了 2010年6月至2016年7月間中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院收治的324例接受新輔助放化療后行腹腔鏡直腸癌根治術(shù)的局部進(jìn)展期直腸癌患者的臨床病理資料,通過隨訪獲得遠(yuǎn)期生存資料,分析不同病理類型局部進(jìn)展期直腸癌對新輔助放化療效果的差異,及臨床病理因素與該組患者遠(yuǎn)期生存之間的關(guān)系。結(jié)果:324例患者中粘液腺癌共28例,非粘液腺癌共296例,粘液腺癌組年齡小于50歲的患者比例為50%,明顯高于非粘液腺癌組的26.4%(p=0.014)。粘液腺癌組患者腫瘤平均直徑及淋巴結(jié)獲取數(shù)均明顯大于非粘液腺癌組(p0.001)。粘液腺癌組術(shù)后T分期(p=0.035)、N分期明顯較晚(p0.001)。粘液腺癌組淋巴結(jié)降期率為32.1%,非粘液腺癌組為62.5%(p=0.002)。粘液腺癌組與非粘液腺癌組3年預(yù)計(jì)無病生存率(DFS)為67.7%和79.6%,差異均無統(tǒng)計(jì)學(xué)意義(p=0.869)。術(shù)后病理結(jié)果為淋巴結(jié)陽性患者3年無病生存率為75.4%,明顯低于術(shù)后淋巴結(jié)陰性患者的88.8%(p0.001)。多因素生存分析顯示術(shù)后淋巴結(jié)狀態(tài)、腫瘤平均直徑、TRG分級、局部浸潤性因素為影響無病生存率的獨(dú)立預(yù)后指標(biāo)(p0.05)。在術(shù)后淋巴結(jié)陽性的112例患者亞組分析中,單因素分析顯示腫瘤大小、TRG分級、淋巴結(jié)陽性率、pN分期是影響術(shù)后淋巴結(jié)陽性患者遠(yuǎn)期預(yù)后相關(guān),多因素分析顯示TRG分級(HR 0.549,p=0.017)、淋巴結(jié)陽性率(HR 0.549,p=0.015)為影響該組患者遠(yuǎn)期預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:本研究顯示進(jìn)展期直腸粘液腺癌新輔助放化療效果較非粘液腺癌差,尤其是對于淋巴結(jié)轉(zhuǎn)移患者。但本研究中兩組間DFS無明顯統(tǒng)計(jì)學(xué)差異,該結(jié)論需要大樣本前瞻性進(jìn)一步研究。新輔助放化療后淋巴結(jié)陽性、腫瘤直徑≥3cm、TRG分級較低、合并脈管瘤栓、神經(jīng)侵犯、癌結(jié)節(jié)等因素是預(yù)示局部進(jìn)展期中低位直腸癌患者不良遠(yuǎn)期預(yù)后的臨床因素。淋巴結(jié)陽性率、TRG分級等因素是影響新輔助放化療后淋巴結(jié)陽性患者遠(yuǎn)期預(yù)后的獨(dú)立危險(xiǎn)因素,淋巴結(jié)陽性率較術(shù)后淋巴結(jié)分期更能反應(yīng)淋巴結(jié)陽性患者遠(yuǎn)期預(yù)后。
[Abstract]:Background and objective: neoadjuvant radiotherapy and chemotherapy combined with radical surgery have become the standard treatment for locally advanced low rectal cancer. Neoadjuvant radiotherapy and chemotherapy can reduce tumor size, decrease regional lymph node stage and reduce local recurrence rate. How to accurately evaluate the long-term prognosis of patients after surgery is an important issue at this stage, at the same time, there are differences in neoadjuvant chemotherapeutic effects among different pathological types of locally advanced rectal cancer. The purpose of this study was to evaluate the clinical significance of laparoscopic radical resection of rectal cancer after neoadjuvant radiotherapy and chemotherapy. Methods: the clinicopathological data of 324 patients with locally advanced rectal cancer undergoing laparoscopic radical resection after neoadjuvant radiotherapy and chemotherapy were collected retrospectively from June 2010 to July 2016 in the Cancer Hospital of the Chinese Academy of Medical Sciences. To analyze the difference of neoadjuvant chemotherapeutic effect of local advanced rectal cancer in different pathological types and the relationship between clinicopathological factors and long-term survival of this group of patients. Results there were 28 cases of mucinous adenocarcinoma and 296 cases of non-mucinous adenocarcinoma. The proportion of mucinous adenocarcinoma patients younger than 50 years old was significantly higher than that of non-mucinous adenocarcinoma group (26.4%, 0.014%). The mean diameter of tumor and the number of lymph nodes in mucinous adenocarcinoma group were significantly larger than those in non-mucinous adenocarcinoma group (P 0.001). In the mucinous adenocarcinoma group, the T stage was significantly later than that in the control group (P 0. 035 and P 0. 001). The descending rate of lymph nodes in mucinous adenocarcinoma group was 32.1%, and that in non-mucinous adenocarcinoma group was 62.5% (P 0.002). The 3-year disease-free survival rate (DFS) of mucinous adenocarcinoma group and non-mucinous adenocarcinoma group was 67.7% and 79.6% respectively, and there was no significant difference between them. The 3-year disease-free survival rate of patients with positive lymph nodes was 75.4, which was significantly lower than that of patients with negative lymph nodes. Multivariate survival analysis showed that postoperative lymph node status, mean tumor diameter and TRG grade, and local infiltration were independent prognostic markers for disease-free survival rate (P 0.05). In the subgroup analysis of 112 patients with positive lymph nodes after operation, univariate analysis showed that the size of tumor, the positive rate of lymph nodes and the PN stage were correlated with the long-term prognosis of the patients with positive lymph nodes after operation. Multivariate analysis showed that the TRG grade of HR was 0.549%, and the positive rate of lymph nodes was 0.549% (P < 0.015) as an independent risk factor for the long-term prognosis of this group of patients. Conclusion: neoadjuvant radiotherapy and chemotherapy in advanced rectal mucinous adenocarcinoma is less effective than that in non-mucinous adenocarcinoma, especially in patients with lymph node metastasis. However, there was no significant difference in DFS between the two groups in this study. This conclusion requires a large sample of prospective further study. After neoadjuvant radiotherapy and chemotherapy, lymph nodes were positive, tumor diameter 鈮，

本文編號：1951176