中华放射肿瘤学杂志
中華放射腫瘤學雜誌
중화방사종류학잡지
Chinese Journal of Radiation Oncology
2015年
6期
627-632
,共6页
陈远贵%徐本华%陆海杰%陈明秋%李小波%郭玉燕%李金銮%吴君心
陳遠貴%徐本華%陸海傑%陳明鞦%李小波%郭玉燕%李金鑾%吳君心
진원귀%서본화%륙해걸%진명추%리소파%곽옥연%리금란%오군심
直肠肿瘤/新辅助疗法%病理完全缓解%因素分析
直腸腫瘤/新輔助療法%病理完全緩解%因素分析
직장종류/신보조요법%병리완전완해%인소분석
Rectal neoplasms/neoadjuvant therapy%Pathologic complete response%Factors analysis
目的：评价局部晚期直肠癌新辅助治疗后pCR的相关影响因素。方法回顾分析2011—2013年间收治的265例AJCC分期Ⅱ、Ⅲ期直肠癌患者资料。所有患者均接受新辅助治疗±等待手术间期化疗，而后手术。运用单因素和二元Logistic回归多因素分析影响pCR的预测因素，并根据预测危险因素进行归类后分为无风险组（无因素）、低风险组（1个因素）、高风险组（2个因素）。建立临床风险评估模型。因素分析运用二元Logistic回归模型。结果达pCR者50例（18．9％）。单因素分析中新辅助治疗前CEA、放化疗前T分期、同期放化疗结束至手术间隔时间和放化疗前肿瘤最大厚度对pCR有影响（ P＝0．017、0．001、0．000、0．040），多因素分析显示新辅助治疗前CEA水平和同期放化疗结束至手术间隔时间是pCR影响因素（ P＝0．021、0．001），进一步分层分析表明只有非吸烟组中新辅助治疗前低水平CEA对pCR有影响（ P＝0．044）。临床风险评估模型诊断pCR的敏感性为80．5％，特异性为46．0％， AUC 为0．690，阳性预测值为35．49％，阴性预测值为86．5％，准确性为73．9％。结论新辅助治疗能使部分局部晚期直肠癌患者达pCR。新辅助治疗前低水平CEA和更长的同期放化疗结束至手术间隔时间是局部晚期直肠癌新辅助治疗pCR的预测因素，而新辅助治疗前低水平CEA对pCR预测只在非吸烟人群中有效。根据新辅助治疗前CEA＞5 ng／ml和同期放化疗结束至手术间隔时间≤8周的危险因素建立的临床风险评估模型可用于预测局部晚期直肠癌新辅助治疗pCR率。
目的：評價跼部晚期直腸癌新輔助治療後pCR的相關影響因素。方法迴顧分析2011—2013年間收治的265例AJCC分期Ⅱ、Ⅲ期直腸癌患者資料。所有患者均接受新輔助治療±等待手術間期化療，而後手術。運用單因素和二元Logistic迴歸多因素分析影響pCR的預測因素，併根據預測危險因素進行歸類後分為無風險組（無因素）、低風險組（1箇因素）、高風險組（2箇因素）。建立臨床風險評估模型。因素分析運用二元Logistic迴歸模型。結果達pCR者50例（18．9％）。單因素分析中新輔助治療前CEA、放化療前T分期、同期放化療結束至手術間隔時間和放化療前腫瘤最大厚度對pCR有影響（ P＝0．017、0．001、0．000、0．040），多因素分析顯示新輔助治療前CEA水平和同期放化療結束至手術間隔時間是pCR影響因素（ P＝0．021、0．001），進一步分層分析錶明隻有非吸煙組中新輔助治療前低水平CEA對pCR有影響（ P＝0．044）。臨床風險評估模型診斷pCR的敏感性為80．5％，特異性為46．0％， AUC 為0．690，暘性預測值為35．49％，陰性預測值為86．5％，準確性為73．9％。結論新輔助治療能使部分跼部晚期直腸癌患者達pCR。新輔助治療前低水平CEA和更長的同期放化療結束至手術間隔時間是跼部晚期直腸癌新輔助治療pCR的預測因素，而新輔助治療前低水平CEA對pCR預測隻在非吸煙人群中有效。根據新輔助治療前CEA＞5 ng／ml和同期放化療結束至手術間隔時間≤8週的危險因素建立的臨床風險評估模型可用于預測跼部晚期直腸癌新輔助治療pCR率。
목적：평개국부만기직장암신보조치료후pCR적상관영향인소。방법회고분석2011—2013년간수치적265례AJCC분기Ⅱ、Ⅲ기직장암환자자료。소유환자균접수신보조치료±등대수술간기화료，이후수술。운용단인소화이원Logistic회귀다인소분석영향pCR적예측인소，병근거예측위험인소진행귀류후분위무풍험조（무인소）、저풍험조（1개인소）、고풍험조（2개인소）。건립림상풍험평고모형。인소분석운용이원Logistic회귀모형。결과체pCR자50례（18．9％）。단인소분석중신보조치료전CEA、방화료전T분기、동기방화료결속지수술간격시간화방화료전종류최대후도대pCR유영향（ P＝0．017、0．001、0．000、0．040），다인소분석현시신보조치료전CEA수평화동기방화료결속지수술간격시간시pCR영향인소（ P＝0．021、0．001），진일보분층분석표명지유비흡연조중신보조치료전저수평CEA대pCR유영향（ P＝0．044）。림상풍험평고모형진단pCR적민감성위80．5％，특이성위46．0％， AUC 위0．690，양성예측치위35．49％，음성예측치위86．5％，준학성위73．9％。결론신보조치료능사부분국부만기직장암환자체pCR。신보조치료전저수평CEA화경장적동기방화료결속지수술간격시간시국부만기직장암신보조치료pCR적예측인소，이신보조치료전저수평CEA대pCR예측지재비흡연인군중유효。근거신보조치료전CEA＞5 ng／ml화동기방화료결속지수술간격시간≤8주적위험인소건립적림상풍험평고모형가용우예측국부만기직장암신보조치료pCR솔。
Objective To evaluate the potential influencing factors associated with pathologic complete response ( pCR) after neoadjuvant chemoradiotherapy for locally advanced rectal cancer ( LARC) . Methods A retrospective analysis was performed on the clinical data 265 patients with stageⅡandⅢ( the 7th version of AJCC) rectal cancer admitted to our hospital from 2011 to 2013. All patients underwent neoadjuvant concurrent chemoradiotherapy ( CCRT ) followed by surgery with/or without induction chemotherapy during the interval between the complete of CCRT and surgery. The predictors associated with pCR were analyzed by univariate and multivariate logistic regression analyses. With the use of the independent predictive variables for pCR from multivariate analysis, a clinical risk score model was established according to the following criteria:no?risk group (0 factor);low?risk group (1 factor);high?risk group ( 2 factors) . Results Among these 265 patients, 50( 18. 9%) achieved pCR. The univariate analysis showed that carcinoembryonic antigen ( CEA) level before CCRT ( P=0. 017) , T stage before CCRT ( P=0. 001), interval between complete of CCRT and surgery (P=0. 000), and the maximum tumor thickness before CCRT ( P=0. 040) were significantly associated with pCR. The multivariate analysis showed that pre?CCRT CEA level ( P=0. 021 or 0. 446) and interval between the complete of CCRT and surgery ( P=0. 000 or 3. 774) were significant predictors of pCR. When stratifying for smoking status, only low pre?CCRT CEA level was significantly associated with pCR in the non?smoking patients ( P=0. 044) . For the prediction of pCR by the clinical risk score model, the sensitivity was 0. 805, the specificity was 0. 460, the area under the receiver operating curve was 0. 690 ( 95% CI= 0. 613?0. 767 ) , the positive predictive value was 35 . 4 9%, the negative predictive value was 8 6 . 5%, and the predictive accuracy was 7 3 . 9%. Conclusions For locally advanced rectal cancer, pCR can be achieved in some patients after neoadjuvant therapy. Low pre?CCRT CEA level and long interval time between CCRT and surgery are independent factors associated with pCR, and only low pre?CCRT CEA level is an associated factor in the group of nonsmokers. The clinical risk score model based on pre?CCRT CEA level>5 ng/ml and time interval from CCRT completion to surgery≤8 weeks can be used to predict pCR after neoadjuvant chemoradiotherapy for LARC.
