CAJ | 학술논문

目的研究新辅助治疗后直肠癌的术后病理分期特征与患者3年无病生存期(DFS)的关系.方法回顾分析2005年1月至2012年12月接受新辅助治疗的直肠癌患者术后生存情况,研究肿瘤浸润深度、淋巴结状况、局部浸润因素(切缘、癌结节、血管神经浸润等)、TNM分期与DFS的关系.结果共入选135例患者,其中男性79例,女性56例,平均年龄(58±12)岁(18 ～ 80岁).患者总体3年DFS为85.2％,完全病理缓解率(pCR)为19.3％,ypTON+者3例,占ypTO患者的10.4％.随着ypT分期和ypTNM分期的进展,DFS有下降的趋势(x2=14.296、52.643,P=0.006、0.000);ypT0-T2期和yp0-Ⅰ期的患者有较好的DFS(分别为93.1％～ 100％和92.3％、97.4％);ypT3、YPⅢB期患者DFS较差(分别为70.2％和46.7％).淋巴结阴性和阳性患者的DFS差异显著(分别为96.8％、58.5％,x2=34.125,P=0.000);是否存在局部浸润因素患者的DFS分别为42.9％、90.1％,差异亦有统计学意义(x2=32.666,P=0.000).多因素分析显示N分期(RR=12.312,95％CI:2.828～ 39.258,P=0.000)和局部浸润因素(RR=5.422,95％ CI:1.202 ～8.493,P=0.020)是DFS的独立预后指标.结论直肠癌新辅助治疗后的病理分期状况与患者的生存预后密切相关,ypT分期和ypTNM分期的进展预示患者预后不良;淋巴结状况和局部浸润因素是生存预后的独立危险因素.
목적 연구신보조치료후직장암적술후병리분기특정여환자3년무병생존기(DFS)적관계.방법 회고분석2005년1월지2012년12월접수신보조치료적직장암환자술후생존정황,연구종류침윤심도、림파결상황、국부침윤인소(절연、암결절、혈관신경침윤등)、TNM분기여DFS적관계.결과 공입선135례환자,기중남성79례,녀성56례,평균년령(58±12)세(18 ～ 80세).환자총체3년DFS위85.2％,완전병리완해솔(pCR)위19.3％,ypTON+자3례,점ypTO환자적10.4％.수착ypT분기화ypTNM분기적진전,DFS유하강적추세(x2=14.296、52.643,P=0.006、0.000);ypT0-T2기화yp0-Ⅰ기적환자유교호적DFS(분별위93.1％～ 100％화92.3％、97.4％);ypT3、YPⅢB기환자DFS교차(분별위70.2％화46.7％).림파결음성화양성환자적DFS차이현저(분별위96.8％、58.5％,x2=34.125,P=0.000);시부존재국부침윤인소환자적DFS분별위42.9％、90.1％,차이역유통계학의의(x2=32.666,P=0.000).다인소분석현시N분기(RR=12.312,95％CI:2.828～ 39.258,P=0.000)화국부침윤인소(RR=5.422,95％ CI:1.202 ～8.493,P=0.020)시DFS적독립예후지표.결론 직장암신보조치료후적병리분기상황여환자적생존예후밀절상관,ypT분기화ypTNM분기적진전예시환자예후불량;림파결상황화국부침윤인소시생존예후적독립위험인소.
Objective The present study assessed the pathological staging features of rectal cancer after neoadjuvant chemoradiotherapy,and its relation to prognosis.Methods Pathologic data related to TNM classification were analyzed on the surgical specimens of 135 patients with mid-low rectal cancer after neoadjuvant themoradiotherapy from 2005 to 2012.Tumor invasion,nodal status,local invasive factors (including cancer deposit,radial margin,perivascular or perineural invasion) were investigated with patients' 3-year disease-free survival (DFS).Results The overall 3-year DFS was 85.2％,with a pathological complete response (pCR) rate of 19.26％.Three out of 29 patients (10.4％) with ypT0 were found to have positive lymph nodes.There was a trend towards decreased survival as the ypT category and ypTNM staging increased (x2 =14.296 and 52.643,P =0.006 and 0.000).ypT0-T2 in T category and yp0-I in TNM staging showed a favorable survival above 92％,while the patients with ypT3,or ypⅢ B had a comparable lower DFS of 70.2％ and 46.7％.DFS in patients with negative lymph node were significantly improved than those with positive nodes (93.5％ vs.66.7％,x2 =34.125,P =0.000).Patients with or without local invasive factor significantly differed in DFS (42.9％ vs.90.1％,x2 =32.666,P =0.000).Cox regression analyze showed that the nodal status (RR =12.312,95％ CI:2.828-39.258,P =0.000) and local invasive factors (RR =5.422,95％ CI:1.202-8.493,P =0.020) were independent risk factors to 3-year survival.As the concept of clinical complete response (cCR) is obscure,there were 27.6％ of patients with ypT0 had normal mucosa or no evidence of tumor by EUS or MRI tests before surgery.Conclusion Postoperative pathologic staging features were closely associated with patient's prognosis.The increasing of ypT or ypTNM staging was correlated to decreasing of DFS.Nodal status,positive radial margin,perivascular and perineural invasion were independent risk factors to DFS.Since cCR did not correlate and could not predict pCR,the ongoing radical surgery could not be avoided even there was no evidence of tumor existing before operation.