中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
10期
990-996
,共7页
王林%李忠武%李明%彭亦凡%顾晋
王林%李忠武%李明%彭亦凡%顧晉
왕림%리충무%리명%팽역범%고진
直肠肿瘤%术前放疗%淋巴结比率%生存率
直腸腫瘤%術前放療%淋巴結比率%生存率
직장종류%술전방료%림파결비솔%생존솔
Rectal neoplasms%Preoperative radiotherapy%Lymph node ratio%Survival rate
目的:探讨淋巴结比率(LNR)对总剂量30 Gy、10次分割(30 Gy/10 f)术前放疗后Ⅲ期直肠癌患者预后的判断价值。方法回顾性分析2003年8月至2009年8月间北京大学肿瘤医院结直肠外科收治的282例中低位局部进展期直肠癌患者的临床资料。全组均予以中国抗癌协会推荐的30 Gy/10 f 术前放疗方案,其生物有效剂量为36 Gy ,照射方式为3D 适型放疗。放疗结束后休息2~4周施行手术治疗。对术后病理显示为淋巴结阳性的108例Ⅲ期病例,结合AJCC分期第七版研究LNR对其3年无病生存率的影响。 LNR根据四分位数分组:小于0.070为LNR1,0.070~0.142为LNR2,0.143~0.307为LNR3,大于0.307为LNR4。结果108例患者3年无病生存率为61.1%。单因素分析结果显示:肿瘤分化程度(P=0.002)、手术方式(P=0.037)、环周切缘状态(P=0.034)、ypN分期(P=0.001)、TNM分期(P=0.000)和LNR(P=0.003)是影响本组患者3年无病生存率的因素。多因素生存分析结果显示:腹会阴联合切除术(P=0.006,HR=2.611,95%CI:1.323~5.153)、G3~4级分化(P=0.015,HR=2.208,95% CI:1.163~4.192)以及ypN2a和ypN2b分期(P=0.024, HR=2.568,95% CI:1.135~5.810和P=0.001,HR=3.759,95% CI:1.776~7.958)是影响本组患者3年无病生存率的独立因素,而LNR未保留于多因素回归模型。配对比较显示,ypN亚分期间的生存差异均有统计学意义(P<0.05),但LNR1与LNR2、LNR2与LNR3以及LNR3与LNR4组间,生存差异均无统计学意义(P>0.05)。分层分析显示,LNR无法在ypN亚分期基础上进一步区分预后。结论在AJCC第七版TNM分期系统基础上,LNR对于30 Gy/10 f术前放疗后的Ⅲ期直肠癌预后判断价值有限,不宜被视为常规评价的指标。
目的:探討淋巴結比率(LNR)對總劑量30 Gy、10次分割(30 Gy/10 f)術前放療後Ⅲ期直腸癌患者預後的判斷價值。方法迴顧性分析2003年8月至2009年8月間北京大學腫瘤醫院結直腸外科收治的282例中低位跼部進展期直腸癌患者的臨床資料。全組均予以中國抗癌協會推薦的30 Gy/10 f 術前放療方案,其生物有效劑量為36 Gy ,照射方式為3D 適型放療。放療結束後休息2~4週施行手術治療。對術後病理顯示為淋巴結暘性的108例Ⅲ期病例,結閤AJCC分期第七版研究LNR對其3年無病生存率的影響。 LNR根據四分位數分組:小于0.070為LNR1,0.070~0.142為LNR2,0.143~0.307為LNR3,大于0.307為LNR4。結果108例患者3年無病生存率為61.1%。單因素分析結果顯示:腫瘤分化程度(P=0.002)、手術方式(P=0.037)、環週切緣狀態(P=0.034)、ypN分期(P=0.001)、TNM分期(P=0.000)和LNR(P=0.003)是影響本組患者3年無病生存率的因素。多因素生存分析結果顯示:腹會陰聯閤切除術(P=0.006,HR=2.611,95%CI:1.323~5.153)、G3~4級分化(P=0.015,HR=2.208,95% CI:1.163~4.192)以及ypN2a和ypN2b分期(P=0.024, HR=2.568,95% CI:1.135~5.810和P=0.001,HR=3.759,95% CI:1.776~7.958)是影響本組患者3年無病生存率的獨立因素,而LNR未保留于多因素迴歸模型。配對比較顯示,ypN亞分期間的生存差異均有統計學意義(P<0.05),但LNR1與LNR2、LNR2與LNR3以及LNR3與LNR4組間,生存差異均無統計學意義(P>0.05)。分層分析顯示,LNR無法在ypN亞分期基礎上進一步區分預後。結論在AJCC第七版TNM分期繫統基礎上,LNR對于30 Gy/10 f術前放療後的Ⅲ期直腸癌預後判斷價值有限,不宜被視為常規評價的指標。
목적:탐토림파결비솔(LNR)대총제량30 Gy、10차분할(30 Gy/10 f)술전방료후Ⅲ기직장암환자예후적판단개치。방법회고성분석2003년8월지2009년8월간북경대학종류의원결직장외과수치적282례중저위국부진전기직장암환자적림상자료。전조균여이중국항암협회추천적30 Gy/10 f 술전방료방안,기생물유효제량위36 Gy ,조사방식위3D 괄형방료。방료결속후휴식2~4주시행수술치료。대술후병리현시위림파결양성적108례Ⅲ기병례,결합AJCC분기제칠판연구LNR대기3년무병생존솔적영향。 LNR근거사분위수분조:소우0.070위LNR1,0.070~0.142위LNR2,0.143~0.307위LNR3,대우0.307위LNR4。결과108례환자3년무병생존솔위61.1%。단인소분석결과현시:종류분화정도(P=0.002)、수술방식(P=0.037)、배주절연상태(P=0.034)、ypN분기(P=0.001)、TNM분기(P=0.000)화LNR(P=0.003)시영향본조환자3년무병생존솔적인소。다인소생존분석결과현시:복회음연합절제술(P=0.006,HR=2.611,95%CI:1.323~5.153)、G3~4급분화(P=0.015,HR=2.208,95% CI:1.163~4.192)이급ypN2a화ypN2b분기(P=0.024, HR=2.568,95% CI:1.135~5.810화P=0.001,HR=3.759,95% CI:1.776~7.958)시영향본조환자3년무병생존솔적독립인소,이LNR미보류우다인소회귀모형。배대비교현시,ypN아분기간적생존차이균유통계학의의(P<0.05),단LNR1여LNR2、LNR2여LNR3이급LNR3여LNR4조간,생존차이균무통계학의의(P>0.05)。분층분석현시,LNR무법재ypN아분기기출상진일보구분예후。결론재AJCC제칠판TNM분기계통기출상,LNR대우30 Gy/10 f술전방료후적Ⅲ기직장암예후판단개치유한,불의피시위상규평개적지표。
Objective To evaluate the prognostic value of the lymph node ratio (LNR) staging system for rectal cancer following 30 Gy/10 f preoperative radiotherapy. Methods Clinical data of 282 patients with mid-lower locally advanced rectal cancer who received preoperative radiotherapy and curative surgery in the Peking University Cancer Hospital from August 2003 to August 2009 were retrospectively reviewed. The radiotherapy regimen was recommended by CACA. Total dose of 30 Gy was divided into 10 fragments (30 Gy/10 f), the biologically equivalent dose (BED) was 36 Gy, and 3D conformal radiotherapy (3D-CRT) was used. Surgery was performed 2-4 weeks after radiation. The prognostic effect of the lymph node ratio (LNR) staging system in addition to the 7th AJCC staging system were retrospectively analyze d and compared in stageⅢ cases with positive lymph node (s).Patients were divided into four groups by LNR quantiles: LNR1 (<0.070), LNR2(0.070-0.142), LNR3(0.143-0.307) and LNR4(>0.307). Results A total of 108 eligible cases were included in the study. The 3-year disease-free survival (3-yr DFS) was 61.1%. On univariate analysis, circumferential resection margin involvement (P=0.034), tumor differentiation (P=0.002), N stage (P=0.001), TNM stage (P=0.000) and LNR (P=0.003) were significantly associated with 3-yr DFS. On multivariate analysis, abdominoperineal resection (P=0.006,HR=2.611,95% CI:1.323-5.153), G3-4 differentiation (P=0.015, HR=2.208, 95% CI:1.163-4.192), ypN2a/N2b stage (as covariate: P=0.024, HR=2.568, 95% CI:1.135-5.810; P=0.001, HR=3.759, 95% CI:1.776-7.958) were independent risk factors for decreased 3-yr DFS. Other factors including LNR were excluded in Cox regression model. The 3-yr DFS was statistically different among subcategories of ypN stage. There was no statistical difference of 3-yr DFS in pair-wise comparison of LNR1&LNR2, LNR2&LNR3 and LNR3 &LNR4. Additional use of LNR over AJCC staging system did not improve the prediction of prognosis for ⅢB/C stages and for each stratum of ypN stages, despite the prognostic separation by LNR in ⅢA stage. Conclusion The LNR staging system in addition to the 7th AJCC staging system does not provide further detailed stratification of the prognosis for stageⅢ rectal cancer following 30 Gy/10 f preoperative radiotherapy. Lymph node ratio is premature as a prognostic factor in clinical practice.