中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2015年
5期
474-477
,共4页
肖毅%薛华丹%仲光熙%周炜洵%徐徕%都雪朝%张冠南%吴斌%林国乐%邱辉忠
肖毅%薛華丹%仲光熙%週煒洵%徐徠%都雪朝%張冠南%吳斌%林國樂%邱輝忠
초의%설화단%중광희%주위순%서래%도설조%장관남%오빈%림국악%구휘충
直肠肿瘤%新辅助治疗%临床完全缓解%病理完全缓解
直腸腫瘤%新輔助治療%臨床完全緩解%病理完全緩解
직장종류%신보조치료%림상완전완해%병리완전완해
Rectal neoplasms%Preoperative chemoradiation%Clinical complete response%Pathological complete response
目的:评价经过新辅助治疗后是否达到临床完全缓解(cCR)对进展期直肠癌患者的临床意义。方法回顾性分析北京协和医院基本外科2005—2014年间接受新辅助治疗的227例进展期直肠癌患者的临床病理资料。通过与术后病理结果进行比较,评估经术前直肠腔内超声(EUS)、磁共振成像(MRI)及术后大体病理观察原发病灶直肠黏膜的完整性3种方法判断新辅助治疗后T分期的准确性。结果术后病理结果显示,45例(19.8%,45/227)患者达到ypT0,其中40例(17.6%)达到病理完全缓解(pCR,ypT0N0),但有5例(11.1%)存在区域淋巴结转移和肠周癌结节。术前EUS、MRI及术后大体病理观察原发病灶直肠黏膜的完整性所评估的cT0预测术后ypT0的敏感度分别为19.4%(6/31)、60.0%(6/10)和17.8%(8/45),特异度分别为90.8%(89/98)、79.5%(31/39)和96.7%(176/182)。多因素Logistic回归分析结果显示,MRI术前对cT0的评估结果可独立预测ypT0(OR=4.975,95% CI:1.073~23.067,P=0.040)。结论进展期直肠癌经过新辅助治疗后据cCR与否来制定治疗方案可能会导致治疗方向的错误;术前MRI对肿瘤T分期检测敏感度高于EUS和原发病灶直肠黏膜完整性与否的大体观察。
目的:評價經過新輔助治療後是否達到臨床完全緩解(cCR)對進展期直腸癌患者的臨床意義。方法迴顧性分析北京協和醫院基本外科2005—2014年間接受新輔助治療的227例進展期直腸癌患者的臨床病理資料。通過與術後病理結果進行比較,評估經術前直腸腔內超聲(EUS)、磁共振成像(MRI)及術後大體病理觀察原髮病竈直腸黏膜的完整性3種方法判斷新輔助治療後T分期的準確性。結果術後病理結果顯示,45例(19.8%,45/227)患者達到ypT0,其中40例(17.6%)達到病理完全緩解(pCR,ypT0N0),但有5例(11.1%)存在區域淋巴結轉移和腸週癌結節。術前EUS、MRI及術後大體病理觀察原髮病竈直腸黏膜的完整性所評估的cT0預測術後ypT0的敏感度分彆為19.4%(6/31)、60.0%(6/10)和17.8%(8/45),特異度分彆為90.8%(89/98)、79.5%(31/39)和96.7%(176/182)。多因素Logistic迴歸分析結果顯示,MRI術前對cT0的評估結果可獨立預測ypT0(OR=4.975,95% CI:1.073~23.067,P=0.040)。結論進展期直腸癌經過新輔助治療後據cCR與否來製定治療方案可能會導緻治療方嚮的錯誤;術前MRI對腫瘤T分期檢測敏感度高于EUS和原髮病竈直腸黏膜完整性與否的大體觀察。
목적:평개경과신보조치료후시부체도림상완전완해(cCR)대진전기직장암환자적림상의의。방법회고성분석북경협화의원기본외과2005—2014년간접수신보조치료적227례진전기직장암환자적림상병리자료。통과여술후병리결과진행비교,평고경술전직장강내초성(EUS)、자공진성상(MRI)급술후대체병리관찰원발병조직장점막적완정성3충방법판단신보조치료후T분기적준학성。결과술후병리결과현시,45례(19.8%,45/227)환자체도ypT0,기중40례(17.6%)체도병리완전완해(pCR,ypT0N0),단유5례(11.1%)존재구역림파결전이화장주암결절。술전EUS、MRI급술후대체병리관찰원발병조직장점막적완정성소평고적cT0예측술후ypT0적민감도분별위19.4%(6/31)、60.0%(6/10)화17.8%(8/45),특이도분별위90.8%(89/98)、79.5%(31/39)화96.7%(176/182)。다인소Logistic회귀분석결과현시,MRI술전대cT0적평고결과가독립예측ypT0(OR=4.975,95% CI:1.073~23.067,P=0.040)。결론진전기직장암경과신보조치료후거cCR여부래제정치료방안가능회도치치료방향적착오;술전MRI대종류T분기검측민감도고우EUS화원발병조직장점막완정성여부적대체관찰。
Objective To evaluate the accuracy and clinical significance of clinical complete response (cCR) after neoadjuvant themoradiotherapy for locally advanced rectal cancer. Methods Locally advanced rectal cancer patients who received neoadjuvant chemoradiotherapy following radical resection were retrospectively assessed for tumor response during 2005 to 2014 from the database of colorectal cancer. The concomitant preoperative chemoradiation consisted of 50 Gy radiation , fractionated within 5 weeks and 5-FU combined with oxaliplatin. Endorectal ultrasound and MRI were applied to preoperative staging, and postoperative gross pathologic inspection was retrospectively employed to evaluate the status of clinical complete response (cCR). Results A total of 227 patients undergoing radical surgery were enrolled in the study. Complete pathological response (ypT0N0, pCR) was found in 40 patients (17.6%) by postoperative pathologic examination while the rate of node involved in ypT0 patients was 11.1%. The preoperative rectal MRI was more sensitive to correlate ypT0 than endorectal ultrasound and gross pathologic inspection (60.0% vs 19.4% and 17.8%), but the accuracy and specificity showed no significant differences among these three tests. Multivariate Logistic regression analysis revealed preoperative MRI evaluation of cT0 might predict ypT0 independently (OR=4.975, 95% CI: 1.073 to 23.067, P=0.040). Conclusion It is difficult to diagnose the primary tumor to be a cCR status based on preoperative MRI, EUS, or ulceration of rectal mucosa, and further to predict pCR. Preoperative MRI is more sensitive. The strategy of “wait and see”for cCR patients after neoadjuvant chemoradiation should be seriously considered in the decision-making before surgery.