上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

129例局限中晚期直肠癌预后的相关因素分析

荣玲1，周荻1，戴立言1，侯艳丽1，白永瑞1，宋少莉2   

  1. 上海交通大学 医学院附属仁济医院 1.放疗科， 2.核医学科， 上海 200127
  • 出版日期:2016-07-28 发布日期:2016-08-31
  • 通讯作者: 宋少莉, 电子信箱: shaoli-song@163.com。
  • 作者简介:荣玲（1982—）， 女， 住院医师， 硕士生; 电子信箱: tomato820108@hotmail.com。
  • 基金资助:

    国家自然科学基金（81471708,81101073）

Analysis of prognostic factors for 129 patients with local advanced rectal cancer

RONG Ling1, ZHOU Di1, DAI Li-yan1, HOU Yan-li1, BAI Yong-rui1, SONG Shao-li2   

  1. 1.Department of Radiation Oncology, 2.Department of Nuclear Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Online:2016-07-28 Published:2016-08-31
  • Supported by:

    National Natural Science Foundation of China, 81471708, 81101073

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摘要：

目的 探讨局限中晚期直肠癌（LARC）患者术后接受放、化疗的效果和影响预后的因素。方法 回顾性分析2005年7月—2010年12月收治的LARC术后给予放疗和/或化疗的患者129例（ⅡA期 23例，ⅡB期 10例，ⅡC期 7例，ⅢA期 5例，ⅢB期 60例，ⅢC 24例），采用适形或调强的放疗方式以及以氟尿嘧啶为基础的化疗方案，对患者的临床、病理和治疗方案等数据材料采用Kaplan-Meier生存率计算方法、Log-rank单因素检验分析预后，采用受试者工作特征曲线（ROC）法计算阳性淋巴结率截点，利用COX多因素模型分析预后。结果 129例患者随访率为99.23%，中位随访时间为39个月。患者的1、3和5年整体生存率（OS）分别为90.7%、57.4%和44.3%。患者的1、3和5年无疾病生存率（DFS）分别为72.1%、46.1%和41.0%。单因素分析法分析预后时发现，N分组、治疗前后癌胚抗原（CEA）和CA199水平、癌结节、分化程度、阳性淋巴结率、血红蛋白（HGB）以及术后辅助化疗是影响直肠癌预后的因素。COX多因素回归分析得出9个独立与预后相关的因素：分化程度(P=0.041)、T浸润深度(P=0.046)、癌结节(P=0.002)、N分组(P=0.002)、术后辅助化疗(P=0.006)、治疗前CA199(P=0.062)、治疗前HGB(P=0.001)、治疗后CEA(P=0.022)、治疗后CA199(P=0.000)，按其检验统计量值大小排列，依次为N分组、治疗后CA199、治疗前HGB、癌结节、T浸润深度、术后辅助化疗、分化程度、治疗后CEA和治疗前CA199。结论 在多学科会诊开展前，术前无法接受新辅助治疗的LARC患者中，给予术后放疗联合化疗的效果肯定；同时，术后病理中的淋巴结、浸润深度、分化程度、癌结节、HGB、CEA和CA199水平与OS及DFS明显相关。

关键词: 直肠癌, 放化疗, 预后

Abstract:

Objective To explore the efficacy of postoperative radiotherapy and chemotherapy in patients with local advanced rectal cancer (LARC) and its prognostic factors. Methods A retrospective analysis of 129 patients with LARC (23 cases of ⅡA stage LARC, 10 cases of ⅡB, 7 cases of ⅡC, 5 cases of ⅢA, 60 cases of ⅢB, and 24 cases of ⅢC) receiving postoperative radiotherapy and/or chemotherapy from July 2005 to September 2010 was performed. The conformal or intensity modulated radiotherapy and fluorouracil-based chemotherapy were used. According to patients’ clinical, pathological, and therapeutic data, Kaplan Meier method was used to calculate the survival rate, log-rank single factor test was used to analyze the prognosis, receiver operating characteristic (ROC) curve method was used to calculate the cut-off point of positive lymph node rate, and Cox proportional hazards model was used to analyze the prognosis. Results The follow-up rate and median follow-up period in 129 patients were 99.23% and 39 months, respectively. The 1, 3, and 5 year overall survival (OS) rates were 90.7%, 57.4%, and 44.3% respectively and the 1, 3, and 5 year disease free survival (DFS) rates were 72.1%, 46.1%, and 41.0% respectively. Single factor analysis of the prognosis showed that lymph node grouping, CEA and CA199 levels before and after treatment, cancer nodule, differentiation, rate of positive lymph node, hemoglobin (HGB), and postoperative adjuvant chemotherapy were factors affecting the prognosis of rectal carcinoma. COX multivariate regression analysis of patients with LARC showed that there were 9 independent factors related to the prognosis, i.e. differentiation (P=0.041), depth of infiltration (P=0.046), cancer nodules (P=0.002), lymph node grouping (P=0.002), postoperative adjuvant chemotherapy (P=0.006), CA199 level before treatment (P=0.062), HGB level before treatment (P=0.001), CEA level after treatment (P=0.022), and CA199 level after treatment (P=0.000). The Wald value of lymph node grouping was the largest, followed by CA199 after treatment, HGB before treatment, cancer nodule, depth of infiltration, postoperative adjuvant chemotherapy, differentiation, CEA after treatment, and CA199 before treatment. Conclusion Before the implementation of multi discipline consultation (MDT) in our hospital, Patients with LARC who are unable to receive preoperative neoadjuvant therapy can benefit from postoperative radiotherapy combined with chemotherapy. Lymph node grouping, infiltration depth, differentiation, tumor nodule, and CEA, HGB, and CA199 levels are significantly correlated to OS and DFS.

Key words: rectal cancer, radiochemotherapy, prognosis