CAJ | 학술논문

目的探讨术后腹腔化疗联合静脉化疗与单纯静脉化疗对浆膜受侵的结直肠癌患者的临床疗效.方法前瞻性非随机将332例浆膜受侵的结直肠癌根治术后患者分为联合化疗组(行腹腔化疗联合静脉化疗166例)和静脉化疗组(行单纯静脉化疗166例),比较两组患者术后腹腔局部复发率、腹腔转移率、肝及其他远处转移率和患者3年、5年总体生存率.结果联合化疗组和静脉化疗组3年、5年总体生存率:ⅡB期两组病例比较,差异无统计学意义(χ2=0.612,P=0.434);Ⅲ期病例两组比较,差异有统计学意义(χ2=3.989,P=0.046).联合化疗组的腹腔局部复发率(1.9%)、腹腔转移率(3.8%)和肝转移率(3.8%)均显著低于静脉化疗组的8.2%、9.5%和10.1%(P<0.05),而两组其他远处(肺、骨、脑)转移率(5.1%比3.8%)比较,差异无统计学意义(P>0.05).联合化疗组中,使用奥沙利铂组腹腔转移率和肝转移率(0.9%和0.9%)均显著低于使用顺铂组(8.8%和8.8%,P<0.05),两组局部复发率和远处转移率(0.9%和4.7%比3.5%和5.3%)比较,差异无统计学意义(P>0.05).结论联合化疗可显著降低浆膜受侵的结直肠癌根治术后患者局部复发率、腹腔转移率与肝转移率,腹腔化疗中奥沙利铂在预防腹腔广泛转移和肝转移方面较顺铂效果更佳.
목적 탐토술후복강화료연합정맥화료여단순정맥화료대장막수침적결직장암환자적림상료효.방법 전첨성비수궤장332례장막수침적결직장암근치술후환자분위연합화료조(행복강화료연합정맥화료166례)화정맥화료조(행단순정맥화료166례),비교량조환자술후복강국부복발솔、복강전이솔、간급기타원처전이솔화환자3년、5년총체생존솔.결과 연합화료조화정맥화료조3년、5년총체생존솔:ⅡB기량조병례비교,차이무통계학의의(χ2=0.612,P=0.434);Ⅲ기병례량조비교,차이유통계학의의(χ2=3.989,P=0.046).연합화료조적복강국부복발솔(1.9%)、복강전이솔(3.8%)화간전이솔(3.8%)균현저저우정맥화료조적8.2%、9.5%화10.1%(P<0.05),이량조기타원처(폐、골、뇌)전이솔(5.1%비3.8%)비교,차이무통계학의의(P>0.05).연합화료조중,사용오사리박조복강전이솔화간전이솔(0.9%화0.9%)균현저저우사용순박조(8.8%화8.8%,P<0.05),량조국부복발솔화원처전이솔(0.9%화4.7%비3.5%화5.3%)비교,차이무통계학의의(P>0.05).결론 연합화료가현저강저장막수침적결직장암근치술후환자국부복발솔、복강전이솔여간전이솔,복강화료중오사리박재예방복강엄범전이화간전이방면교순박효과경가.
Objective To compare the clinical efficacy of postoperative intraperitoneal chemotherapy combined with systemic chemotherapy to systemic chemotherapy alone for serosa-involved colorectal cancer. Methods According to the criteria of serosa-involving in colorectal cancer, 332 cases were divided into 2 groups prospectively without randomization. Study group (n=166) was treated with intraperitoneal chemotherapy combined with systemic chemotherapy, and control group (n=166) with systemic chemotherapy alone. Incidence of local recurrence, peritoneal metastasis, hepatic metastasis, other distant metastasis and 3-year, 5-year overall survival (OS) rate of two groups were compared. Results 3-year and 5-year OS rates of stage Ⅱ B in study group were similar to those in control group (χ2=0.612,P=0.434). The above rates of stage Ⅲ in study group were higher than those in control group (χ2=3.989,P=0.046). Either the study group or the control group, the 3-year and 5-year OS rates of patients undergone laparoscopic surgery or open surgery were similar (P=0.839, P=0.172). Incidences of local recurrence, peritoneal metastasis and hepatic metastasis in study group were 1.9%, 3.8% and 3.8% respetively, lower than those in control group (8.2%,9.5% and 10.1%,P<0.05). Distant metastasis rate in study group was similar to that in control group. In study group, intraperitoneal chemotherapy regimen with Oxaliplatin had lower rates of peritoneal metastasis and hepatic metastasis as compared to that with Cisplatin (0.9% vs 8.8% ,P=0.019), while the incidences of local recurrence and other distant metastasis were similar. Conclusions Postoperative intraperitoneal chemotherapy combined with systemic chemotherapy improves 3-year and 5-year overall survival rates in patients with stage Ⅲ serosa-involved colorectal cancer, and decreases local recurrence, peritoneal metastasis and liver metastasis rate, especially when intraperitoneal chemotherapy regimen contains Oxaliphtin. Comparing with open surgery, laparoscopic surgery dose not improve 3-year and S-year overall survival rates in patients receiving combined chemotherapy or systemic chemotherapy alone.