上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (3): 320-332.doi: 10.3969/j.issn.1674-8115.2023.03.008

• 论著 · 循证医学 • 上一篇    

放疗对行化疗和手术的直肠癌患者的效果分析：一项基于SEER数据库的回顾性研究

王安君(), 刘宁宁()   

  1. 上海交通大学公共卫生学院，上海 200025
  • 收稿日期:2022-08-18 接受日期:2022-12-09 出版日期:2023-03-28 发布日期:2023-03-28
  • 通讯作者: 刘宁宁 E-mail:wanganjun@sjtu.edu.cn;liuningning@shsmu.edu.cn
  • 作者简介:王安君（1994—），女，硕士生；电子信箱：wanganjun@sjtu.edu.cn。
  • 基金资助:
    国家重点研发计划(2020YFA0907200);国家自然科学基金(31900129)

Efficacy of radiotherapy in patients with rectal cancer undergoing chemotherapy and surgery: a retrospective study based on the SEER database

WANG Anjun(), LIU Ningning()   

  1. Shanghai Jiao Tong University School of Public Health, Shanghai 200025, China
  • Received:2022-08-18 Accepted:2022-12-09 Online:2023-03-28 Published:2023-03-28
  • Contact: LIU Ningning E-mail:wanganjun@sjtu.edu.cn;liuningning@shsmu.edu.cn
  • Supported by:
    National Key R&D Program of China(2020YFA0907200);National Natural Science Foundation of China(31900129)

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摘要：

目的·利用美国癌症监测、流行病学和结果（Surveillance，Epidemiology and End Results，SEER）数据库评估新辅助放射治疗（放疗）和辅助放疗对行化学治疗（化疗）和手术的直肠癌患者生存的影响。方法·纳入SEER数据库2005—2015年经病理确诊为直肠癌，并接受化疗和手术治疗的患者；排除尸检或仅死亡证明为直肠癌、无随访时间和临床资料不全的患者。将所有患者分为新辅助放疗联合手术组（RT+S组）、手术治疗组（S组）和手术联合辅助放疗组（S+RT组）。采用倾向性评分匹配（propensity score matching，PSM）以1∶1的比例匹配各组纳入对象，采用受限平均生存时间（restricted mean survival time，RMST）估计直肠癌患者5年和10年内平均生存期，采用Cox比例风险模型确定新辅助放疗和辅助放疗对直肠癌患者总生存期（overall survival，OS）和肿瘤特异性生存期（cancer specific survival，CSS）的影响，通过对患者进行分层分析确定新辅助放疗和辅助放疗的具体获益人群。结果·2005—2015年，共纳入8 975例接受化疗和手术的直肠癌患者；其中S组1 079例，RT+S组5 991例，S+RT组1 905例。经PSM后，各组临床基础特征均衡可比。PSM后，与S组相比，RT+S组患者5年和10年的预后均显著改善（均P=0.000），而S+RT组患者仅5年预后显著改善（均P<0.05），10年预后改善不明显（均P>0.05）。多因素Cox回归分析结果显示，新辅助放疗是患者OS和CSS的独立保护因素（均P=0.000），而辅助放疗并不是（均P>0.05）。亚组分析显示：新辅助放疗对于年龄<50岁、肿瘤分化程度高、肿瘤直径≤30 mm或TNM分期Ⅰ~Ⅲ期患者OS和CSS没有明显的保护作用（均P>0.05）；而辅助放疗对于肿瘤低分化/未分化、肿瘤直径>50 mm或TNM分期Ⅳ期的患者OS和CSS有明显的保护作用（均P<0.05）。结论·对于行化疗和手术的直肠癌患者，新辅助放疗有明显的生存获益，但可能不适用于年龄<50岁、肿瘤分化程度高、肿瘤直径≤30 mm或TNM分期Ⅰ~Ⅲ期的患者；而肿瘤低分化/未分化、肿瘤直径>50 mm或TNM分期Ⅳ期的患者可能从辅助放疗中获益。

关键词: 直肠癌, 新辅助放疗, 辅助放疗, SEER数据库, 预后

Abstract:

Objective ·To evaluate the survival effects of neoadjuvant radiation therapy and adjuvant radiotherapy on the patients with rectal cancer treated with chemotherapy and surgery by using the Surveillance, Epidemiology and End Results (SEER) database of the United States. Methods ·The patients with pathologically confirmed rectal cancer and treated with chemotherapy and surgical resection from 2005 to 2015 in the SEER database were included; the patients with autopsy or death-only proof of rectal cancer, or without follow-up time and incomplete clinical data were excluded. All the patients were divided into neoadjuvant radiotherapy combined with surgery group (RT+S group), surgical treatment group (S group) and surgery combined with adjuvant radiotherapy group (S+RT group). The propensity score matching (PSM) was used to match the included subjects in each group at the 1∶1 ratio, and the restricted mean survival time (RMST) was used to estimate the mean survival of rectal cancer patients over 5 and 10 years. Cox proportional risk models were used to determine the effects of neoadjuvant and adjuvant radiotherapies on overall survival (OS) and tumor-specific survival (CSS) in the patients with rectal cancer, and the specific benefit groups of neoadjuvant and adjuvant radiotherapies were determined by stratified analysis of patients. Results ·From 2005 to 2015, 8 975 patients with rectal cancer who received chemotherapy and surgery were included, including 1 079 in the S group, 5 991 in the RT+S group, and 1 905 in the S+RT group. After PSM, the clinical base characteristics of the groups were balanced and comparable. The patients in the RT+S group had a significantly improved prognosis in 5 and 10 years compared with the S group (all P=0.000) after PSM, while the patients in the S+RT group had a significantly improved prognosis in 5 years only (both P<0.05) and no significant improvement in 10 years (both P>0.05). Multivariate Cox regression analysis showed that neoadjuvant radiotherapy was an independent protective factor for the patients′ OS and CSS (both P=0.000), while adjuvant radiotherapy was not (both P>0.05). Subgroup analysis showed that neoadjuvant radiotherapy had no significant protective effect on OS and CSS in the patients aged<50 years, with highly differentiated tumors, tumor size≤30 mm or TNM stage Ⅰ?Ⅲ (all P>0.05); whereas adjuvant radiotherapy had significant protective effects on OS and CSS in the patients with poorly differentiated/undifferentiated tumors, tumor size>50 mm or TNM stage Ⅳ (all P<0.05). Conclusion ·For the patients with rectal cancer treated with chemotherapy and surgery, neoadjuvant radiotherapy has a significant survival benefit, but it may not be applicable for the patients aged<50 years, with highly differentiated tumors, tumor size≤30 mm, or TNM stage Ⅰ?Ⅲ; whereas the patients with poorly differentiated/undifferentiated tumors, tumor size>50 mm, or TNM stage Ⅳ may benefit from adjuvant radiotherapy.

Key words: rectum cancer, neoadjuvant radiotherapy, adjuvant radiotherapy, SEER database, prognosis

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