摘要
目的 探讨全程新辅助治疗(TNT)模式在高危局部进展期直肠癌(LARC)中的应用疗效。方法 采用回顾性队列研究的方法,分析我院2018年6月至2020年5月收治的106例高危LARC患者的临床资料,根据辅助治疗方案的差异分为新辅助放化疗(nCRT)组(56例)和TNT组(50例),所有患者经辅助治疗后均行全直肠系膜切除(TME)术。比较两组临床完全缓解(cCR)率、病理完全缓解(pCR)率、放化疗不良反应、围手术期并发症、肿瘤标志物癌胚抗原(CEA)、糖类抗原125(CA125)水平及术后无病生存时间(DFS)。结果 TNT组患者治疗后cCR或pCR率为34.00%(17/50),明显高于nCRT组患者14.29%(8/56),两组间TRG分级比较无明显差异,但TNT组达到TRG 0级(pCR)比率更高,差异有统计学意义(P<0.05)。两组间放化疗不良反应及围手术期并发症发生率无明显差异(P>0.05)。经重复测量方差分析,TNT组CEA、CA125水平明显低于nCRT组(P<0.05)。随访时间12~52个月,nCRT组有11例患者出现了远处转移,12例出现局部复发。TNT组有7例患者出现了远处转移,6例出现局部复发。经Log-rank检验,TNT组患者术后DFS显著高于nCRT组,差异有统计学意义(χ^(2)=4.677,P=0.031)。结论 TNT治疗模式在不增加放化疗不良反应及围手术期并发症的前提下能够明显促进高危LARC患者肿瘤消退,改善患者生存预后。
Objective To evaluate the efficacy of whole course neoadjuvant therapy(TNT)in high-risk locally advanced rectal cancer(LARC). Methods From June 2018 to may 2020,a retrospective cohort study was conducted to analyze clinical data of 106 high-risk LARC patients in our hospital. According to difference of adjuvant therapy, they were divided into neoadjuvant chemoradiotherapy(NCRT)group(56 cases)and TNT group(50 cases). All patients underwent total mesorectal excision(TME)after adjuvant therapy. Clinical complete remission(CCR),pathological complete remission(PCR),adverse reactions of radiotherapy and chemotherapy, perioperative complications and postoperative disease-free survival(DFS)were compared.Results After treatment, rate of CCR or PCR in TNT group was 34.00%(17/50),which was significantly higher than that in NCRT group 14.29%(8/56). There was no significant difference in TRG grade between two groups, but rate of trg0 grade(PCR)in TNT group was high with statistically significant difference(P<0.05). There was no significant difference in the incidence of adverse reactions and perioperative complications(P>0.05). During follow-up period of 12~52 months, there were 11 patients with distant metastasis and 12 patients with local recurrence in NCRT group. In TNT group, 7 patients had distant metastasis and 6 patients had local recurrence. By log rank test, postoperative DFS of TNT group was significantly higher than that of NCRT group with statistically significant difference(χ^(2)=4.677,P=0.031).Conclusion TNT treatment mode could be significantly promote tumor regression and improve survival prognosis of high-risk LARC patients without increasing the adverse reactions of radiotherapy and chemotherapy and perioperative complications.
作者
姚远
李宝
潘晓飞
刘锐
李栋梁
Yao Yuan;Li Bao;Pan Xiaofei(Colorectal and Anal Surgery,Affiliated Hospital of Wanxi Health Vocational College,Luan,Anhui 237000,China)
出处
《四川医学》
CAS
2023年第1期1-6,共6页
Sichuan Medical Journal
基金
2020年度安徽省高校自然科学研究重点项目(编号:KJ2020A0961)
2020年度六安市人民医院院级科研课题青年项目(编号:2020kykt21)。
关键词
全程新辅助治疗
新辅助放化疗
高危
局部进展期直肠癌
无病生存时间
whole course neoadjuvant therapy
neoadjuvant chemoradiotherapy
high-risk
locally advanced rectal cancer
disease free survival time
