摘要
目的探讨影响直肠癌新辅助放化疗后病理完全缓解的相关预测因素。方法回顾性分析2007年1月至2013年5月间福建医科大学附属协和医院结直肠外科同一组医师收治的163例直肠癌新辅助放化疗及手术的临床资料。采用单因素分析及Logistic多因素分析法研究病理完全缓解（pCR）的相关预测因素。结果全组患者新辅助放化疗后有29例（17.8％，29／163）达pCR。单因素分析结果显示，肿瘤占据肠腔环周比例小于或等于1／2周（P=0．018）、病理类型为非黏液腺癌（P=0．036）、分化程度为高分化或中分化（P=0．021）及放化疗前CEA小于或等于2．5μg／L（P=-0．007）与直肠癌新辅助放化疗后高pCR率有关。多因素回归分析结果显示，肿瘤占据肠腔环周比例小于或等于1／2周（OR=2．901，P=0．020）和放化疗前CEA小于或等于2．5μg／L（OR=2．775，P-0．022）是影响直肠癌新辅助放化疗后pCR的独立因素。结论肿瘤占据肠腔环周比例和放化疗前CEA检测水平有助于预测直肠癌新辅助放化疗后的pCR率。
Objective To explore predictive factors associated with pathologic complete response （pCR） after neoadjuvant chemoradiotherapy for rectal cancer. Methods Clinicopathological data of 163 patients with locally advanced rectal cancer who were treated with neoadjuvant chemoradiotherapy followed by radical surgical resection from January 2007 to May 2013 were analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were performed to analyze associated factors of pCR, including age, gender, body mass index （BMI）, diabetes, anemia, tumor diameter, distance of the tumor from the anal verge, circumferential extent of the tumor, tumor pathological types, tumor differentiation, pre-chemoradiotherapy T stage, pre-chemoradiotherapy N stage, preehemoradiotherapy CEA level, pre-chemoradiotherapy CA199 level, per-operation CEA level, preoperation CA199 level, radiation dose, chemotherapy modality, time interval from completion of chemoradiotherapy to surgery, etc. Results Twenty-nine patients （17.8%） achieved pCR after neoadjuvant chemoradiotherapy for rectal cancer. Univariate analysis showed circumferential extent of tumor （ ≥1/2 cycle） （P=0.018）, tumor pathological types （adenocarcinoma） （P=0.036）, tumor differentiation （moderate or high）（P=0.021） and pre-chemoradiotherapy CEA level （≤2.5 μg/L）（P=0.007） were significantly correlated with pCR after neoadjuvant chemoradiotherapy for rectal cancer. Logistic regression revealed that circumferential extent of tumor （≥ 1/2 cycle）（OR=2.901, P=0.020） and prechemoradiotherapy CEA level （≤2.5 μg/L）（OR=2.775, P=0.022） were independent predictive factors of pCR after neoadjuvant chemoradiotherapy for rectal cancer. Conclusion Patients with circumferential extent of tumor ≤1/2 and pre-chemoradiotherapy CEA level ≤2.5 μg/L are more likely to achieve pCR after neoadjuvant chemoradiotherapy for rectal cancer, and these two indices can be used to predict pCR after neoadjuvant chemoradiotherapy for rectal cancer.
出处
《中华胃肠外科杂志》
CAS
CSCD
2014年第6期556-560,共5页
Chinese Journal of Gastrointestinal Surgery
基金
卫生部国家临床重点专科建设资助项目（卫办医政函[2012]649号）
关键词
直肠肿瘤
新辅助治疗
病理完全缓解
多因素分析
Rectal neoplasms
Neoadujvant chemoradiotherapy
Pathologic complete response
Multivariate analysis
