中华肿瘤杂志
中華腫瘤雜誌
중화종류잡지
CHINESE JOURNAL OF ONCOLOGY
2013年
9期
708-713
,共6页
游凯云%彭海花%高远红%陈利%周冠群%常晖%杜晓京%肖林%曾智帆
遊凱雲%彭海花%高遠紅%陳利%週冠群%常暉%杜曉京%肖林%曾智帆
유개운%팽해화%고원홍%진리%주관군%상휘%두효경%초림%증지범
直肠肿瘤%肿瘤分期%新辅助放化疗%术后辅助化疗%预后
直腸腫瘤%腫瘤分期%新輔助放化療%術後輔助化療%預後
직장종류%종류분기%신보조방화료%술후보조화료%예후
Rectal neoplasms%Neoplasm staging%Neoadjuvant chemoradiotherapy%Adjuvant chemotherapy%Prognosis
目的 探讨局部晚期直肠癌术前新辅助放化疗后ypT1～4N0期患者术后辅助化疗的价值.方法 收集2003年3月至2010年12月间,经术前同期放化疗及根治性手术后病理检查证实为ypT1～4N0期的局部晚期直肠癌患者104例,其中术后辅助化疗73例,术后未化疗31例；ypT1～2期39例,ypT3 ～4期65例.对全组患者和亚组患者进行生存分析.结果 中位随访时间为41个月.全组104例ypT1～4N0期患者的3年总生存率和无复发生存率分别为93.4％和85.3％,其中术后辅助化疗组患者的3年总生存率和无复发生存率分别为95.5％和88.6％；术后未化疗组患者的3年总生存率和3年无复发生存率分别为88.6％和77.2％.术后辅助化疗组与术后未化疗组患者总生存曲线和无复发生存曲线的差异均无统计学意义(P值分别为0.106和0.108).术后辅助化疗组患者的3年局部复发率和远处转移率分别为4.1％(3/73)和5.5％(4/73);术后未化疗组患者的3年局部复发率和远处转移率分别为3.2％(1/31)和16.1％(5/31).术后辅助化疗组与术后未化疗组患者的局部复发差异无统计学意义(P=0.676),远处转移差异有统计学意义(P=0.030).亚组分析的结果显示,在ypT1 ～2N0期患者中,术后辅助化疗组与术后未化疗组患者的总生存曲线和无复发生存曲线的差异均无统计学意义(P值分别为0.296和0.939),术后辅助化疗组与术后未化疗组患者的局部复发和远处转移差异均无统计学意义(P值分别为0.676和0.414).在ypT3～4N0期患者中,术后辅助化疗组与术后未化疗组患者的总生存曲线和无复发生存曲线的差异均有统计学意义(P值分别为0.034和0.025).术后辅助化疗组与术后未化疗组患者的局部复发差异无统计学意义(P=0.548),远处转移差异有统计学意义(P=0.010).结论 术后辅助化疗能降低局部晚期直肠癌术前新辅助放化疗后ypT3～ 4N0期患者的远处转移率,从而改善其预后,但并不能使ypT1～ 2N0期患者的生存获益.
目的 探討跼部晚期直腸癌術前新輔助放化療後ypT1～4N0期患者術後輔助化療的價值.方法 收集2003年3月至2010年12月間,經術前同期放化療及根治性手術後病理檢查證實為ypT1～4N0期的跼部晚期直腸癌患者104例,其中術後輔助化療73例,術後未化療31例；ypT1～2期39例,ypT3 ～4期65例.對全組患者和亞組患者進行生存分析.結果 中位隨訪時間為41箇月.全組104例ypT1～4N0期患者的3年總生存率和無複髮生存率分彆為93.4％和85.3％,其中術後輔助化療組患者的3年總生存率和無複髮生存率分彆為95.5％和88.6％；術後未化療組患者的3年總生存率和3年無複髮生存率分彆為88.6％和77.2％.術後輔助化療組與術後未化療組患者總生存麯線和無複髮生存麯線的差異均無統計學意義(P值分彆為0.106和0.108).術後輔助化療組患者的3年跼部複髮率和遠處轉移率分彆為4.1％(3/73)和5.5％(4/73);術後未化療組患者的3年跼部複髮率和遠處轉移率分彆為3.2％(1/31)和16.1％(5/31).術後輔助化療組與術後未化療組患者的跼部複髮差異無統計學意義(P=0.676),遠處轉移差異有統計學意義(P=0.030).亞組分析的結果顯示,在ypT1 ～2N0期患者中,術後輔助化療組與術後未化療組患者的總生存麯線和無複髮生存麯線的差異均無統計學意義(P值分彆為0.296和0.939),術後輔助化療組與術後未化療組患者的跼部複髮和遠處轉移差異均無統計學意義(P值分彆為0.676和0.414).在ypT3～4N0期患者中,術後輔助化療組與術後未化療組患者的總生存麯線和無複髮生存麯線的差異均有統計學意義(P值分彆為0.034和0.025).術後輔助化療組與術後未化療組患者的跼部複髮差異無統計學意義(P=0.548),遠處轉移差異有統計學意義(P=0.010).結論 術後輔助化療能降低跼部晚期直腸癌術前新輔助放化療後ypT3～ 4N0期患者的遠處轉移率,從而改善其預後,但併不能使ypT1～ 2N0期患者的生存穫益.
목적 탐토국부만기직장암술전신보조방화료후ypT1～4N0기환자술후보조화료적개치.방법 수집2003년3월지2010년12월간,경술전동기방화료급근치성수술후병리검사증실위ypT1～4N0기적국부만기직장암환자104례,기중술후보조화료73례,술후미화료31례；ypT1～2기39례,ypT3 ～4기65례.대전조환자화아조환자진행생존분석.결과 중위수방시간위41개월.전조104례ypT1～4N0기환자적3년총생존솔화무복발생존솔분별위93.4％화85.3％,기중술후보조화료조환자적3년총생존솔화무복발생존솔분별위95.5％화88.6％；술후미화료조환자적3년총생존솔화3년무복발생존솔분별위88.6％화77.2％.술후보조화료조여술후미화료조환자총생존곡선화무복발생존곡선적차이균무통계학의의(P치분별위0.106화0.108).술후보조화료조환자적3년국부복발솔화원처전이솔분별위4.1％(3/73)화5.5％(4/73);술후미화료조환자적3년국부복발솔화원처전이솔분별위3.2％(1/31)화16.1％(5/31).술후보조화료조여술후미화료조환자적국부복발차이무통계학의의(P=0.676),원처전이차이유통계학의의(P=0.030).아조분석적결과현시,재ypT1 ～2N0기환자중,술후보조화료조여술후미화료조환자적총생존곡선화무복발생존곡선적차이균무통계학의의(P치분별위0.296화0.939),술후보조화료조여술후미화료조환자적국부복발화원처전이차이균무통계학의의(P치분별위0.676화0.414).재ypT3～4N0기환자중,술후보조화료조여술후미화료조환자적총생존곡선화무복발생존곡선적차이균유통계학의의(P치분별위0.034화0.025).술후보조화료조여술후미화료조환자적국부복발차이무통계학의의(P=0.548),원처전이차이유통계학의의(P=0.010).결론 술후보조화료능강저국부만기직장암술전신보조방화료후ypT3～ 4N0기환자적원처전이솔,종이개선기예후,단병불능사ypT1～ 2N0기환자적생존획익.
Objective The purpose of this study was to investigate the value of postoperative chemotherapy for locally advanced rectal cancer patients who reached pathological ypT1-4N0 after neoadjuvant chemoradiotherapy.Methods We performed a retrospective study of 104 patients treated with preoperative chemoradiotherapy followed by radical resection,who achieved pathological ypT1-4N0,between Mar 2003 and Dec 2010.There were 73 patients who received postoperative adjuvant chemotherapy,and the other 31 patients did not.The distribution of final pathologic stages for these patients was ypT1-2N0 in 39 cases and ypT3-4N0 in 65 cases.Results The median follow-up was 41 months.The 3-year overall survival rate (OS) and recurrence-free survival rate (RFS) for the whole group (ypT1-4N0) were 93.4％and 85.3％,respectively.The 3-year OS and RFS in the adjuvant chemotherapy group and non-adjuvant chemotherapy group were 95.5％,88.6％ and 88.6％,77.2％,respectively.There were no significant differences in 3-year RFS (P =0.108) and OS (P =0.106) between the two groups.The 3-year local recurrence and distant metastasis rates in the adjuvant chemotherapy group were 4.1％ (3/73)and 5.5％ (4/73),while for the non-adjuvant chemotherapy group,the 3-year local recurrence rate and distant metastasis rate were 3.2％ (1/31) and 16.1％ (5/31),respectively.Significant difference was found in distant metastasis rates (P =0.030)between the two groups,but not in local recurrence rates(P =0.676).Further subgroup analysis indicated that for the ypT1-2N0 patients,there were no significant differences in 3-year OS (P =0.296) and RFS (P =0.939) between the adjuvant and non-adjuvant chemotherapy groups,while negative results displayed in 3-year local recurrence rates (P =0.676) and distant metastasis rates (P =0.414).However,for patients with ypT3-4N0,significant differences were showed in both the 3-year OS (P =0.034) and RFS (P =0.025),and further analysis revealed that the 3-year distant metastasis rate was significantly higher in the non-adjuvant chemotherapy group than in the adjuvant chemotherapy group (P =0.010),but with non-significant difference in the 3-year local recurrence (P =0.548).Conclusions Adjuvant chemotherapy may not improve survival for ypT1-2N0 patients.However,it may be clinically meaningful for ypT3-4N0 patients by decreasing distant metastasis rate.Further randomized controlled clinical trials are needed to confirm our results.
