[1]杨建国,陈清伟,李金豆,等.直肠癌新辅助放化疗与手术间隔时间对临床和肿瘤学结局的影响[J].医学信息,2020,33(10):90-95.[doi:10.3969/j.issn.1006-1959.2020.10.024]
　YANG Jian-guo,CHEN Qing-wei,LI Jin-dou,et al.Effects of Neoadjuvant Radiochemotherapy and Operation Interval of Rectal Cancer on Clinical and Oncological Outcomes[J].Medical Information,2020,33(10):90-95.[doi:10.3969/j.issn.1006-1959.2020.10.024]
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直肠癌新辅助放化疗与手术间隔时间对临床和肿瘤学结局的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年10期
页码:
90-95
栏目:
论著
出版日期:
2020-05-15

文章信息/Info

Title:
Effects of Neoadjuvant Radiochemotherapy and Operation Interval of Rectal Cancer on Clinical and Oncological Outcomes
文章编号:
1006-1959（2020）10-0090-06
作者:
杨建国; 陈清伟; 李金豆; 等
（重庆医科大学附属第一医院胃肠外科，重庆400016）
Author(s):
YANG Jian-guo; CHEN Qing-wei; LI Jin-dou; et al
(Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
关键词:
新辅助放化疗; 直肠癌; 病理完全缓解; 肿瘤学结局
Keywords:
Neoadjuvant radiochemotherapy; Rectal cancer; Pathological complete remission;  Oncological outcome
分类号:
R735.3
DOI:
10.3969/j.issn.1006-1959.2020.10.024
文献标志码:
A
摘要:
目的 评估延长局部进展期中、低位直肠癌放疗后手术间隔时间至70天对短期临床结局及肿瘤学结局的影响。方法 新辅助放化疗局部进展期直肠癌患者，根据放疗后与手术间隔时间分为短间隔组（＜70天）58例和长间隔组（≥70天）65例，分析手术间隔时间与手术难度、术后并发症、病理完全缓解、无疾病生存期及总生存期的关系。结果 两组患者基本信息、新辅助放化疗前肿瘤临床特征比较，差异无统计学意义（P＞0.05）。长间隔组手术时间高于短间隔组，短间隔组中低位直肠癌保肛率（62.07%）高于长间隔组（55.38%），短间隔组吻合口瘘发生率（2.78%）低于长间隔组（13.89%），但差异无统计学意义（P＞0.05）。短间隔组降期率高于长间期组（P＜0.05）；长间隔组术后病理完全缓解率（16.92%）高于短间隔组（15.52%），但差异无统计学意义（P＞0.05）；多因素分析显示病理完全缓解与间隔时间无关。中位随访时间为39（6~84）个月，短间隔组3年无疾病进展期为75.86%，高于长间隔组的66.20%，但差异无统计学意义（P＞0.05）。短间隔组3年总生存期为86.20%，长于长间隔组的83.10%，但差异无统计学意义（P＞0.05）。结论 局部进展期直肠癌新辅助放化疗后延长手术间隔时间至70天会增加手术时间，但对保肛率、病理完全缓解率、短期临床结局以及肿瘤学结局无明显影响。
Abstract:
Objective To evaluate the effect of prolonging the interval between local and advanced rectal cancer surgery after radiotherapy to 70 d on short-term clinical outcomes and oncological outcomes.Methods Neoadjuvant radiotherapy and chemotherapy patients with locally advanced rectal cancer were divided into short-interval group (＜70 d) 58 cases and long-interval group (≥70 d) 65 cases according to the interval between radiotherapy and surgery. The interval between surgery and difficulty of surgery and postoperative complications were analyzed.Syndrome,pathological complete remission, disease-free survival and overall survival.Results The basic information of the two groups of patients and the clinical characteristics of the tumor before neoadjuvant radiotherapy and chemotherapy were compared,the difference was not statistically significant (P＞0.05). The operation time of the long-interval group was higher than that of the short-interval group, the anus-preserving rate (62.07%) of middle and low rectal cancer in the short-interval group was higher than that of the long-interval group (55.38%), and the incidence of anastomotic leakage (2.78%) in the short-interval group was lower than that of the long-interval group interval group (13.89%), but the difference was not statistically significant (P＞0.05).The rate of decline in the short interval group was higher than that in the long interval group(P＜0.05); the pathological complete remission rate (16.92%) in the long interval group was higher than that in the short interval group (15.52%), but the difference was not statistically significant (P＞0.05); multivariate analysis showed the complete remission of the pathology has nothing to do with the interval time. The median follow-up time was 39 (6 to 84) months. The 3-year period of disease-free progression in the short-interval group was 75.9%, which was higher than 66.20% in the long-interval group. The 3-year overall survival time of the short-interval group was 86.20%, longer than that of the long-interval group 83.10%, but the difference was not statistically significant (P＞0.05).Conclusion Prolonged operation interval to 70 d after neoadjuvant radiotherapy and chemotherapy for locally advanced rectal cancer will increase the operation time, but it has no significant effect on the rate of anus preservation, pathological complete remission rate, short-term clinical outcome and oncological outcome.

参考文献/References:

[1]Bray F,Ferlay J,Soerjomataram I,et al.Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J].CA Cancer J Clin,2018,68(6):394-424. [2]Sung SY,Jang HS,Kim SH,et al.Oncologic Outcome and Morbidity in the Elderly Rectal Cancer Patients After Preoperative Chemoradiotherapy and Total Mesorectal Excision:A Multi-institutional and Case-matched Control Study[J].Ann Surg,2019,269(1):108-113. [3]Li Y,Wang J,Ma X,et al.A Review of Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer[J].Int J Biol Sci,2016,12(8):1022-1031.[4]Huang MY,Lee HH,Tsai HL,et al.Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer[J].Radiat Oncol,2018,13(1):53.[5]Cotte E,Passot G,Decullier E,et al.Pathologic Response,When Increased by Longer Interval,Is a Marker but Not the Cause of Good Prognosis in Rectal Cancer:17-year Follow-up of the Lyon R90-01 Randomized Trial[J].Int J Radiat Oncol Biol Phys,2016,94(3):544-553. [6]Benson AB,Venook AP,Al-Hawary MM,et al.Rectal Cancer,Version 2.2018, NCCN Clinical Practice Guidelines in Oncology[J].J Natl ComprCancNetw,2018,16(7):874-901.[7]Lefevre JH,Mineur L,Kotti S,et al.Effect of Interval(7 or 11 weeks)Between Neoadjuvant Radiochemotherapy and Surgery on Complete Pathologic Response in Rectal Cancer:A Multicenter,Randomized,Controlled Trial(GRECCAR-6)[J].J Clin Oncol,2016,34(31):3773-3780. [8]Rombouts AJM,Hugen N,Elferink MAG,et al.Treatment Interval between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer Patients:A Population-Based Study[J].Ann Surg Oncol,2016,23(11):3593-3601. [9]Zeng WG,Zhou ZX,Liang JW,et al.Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome[J].J Surg Oncol,2014,110(4):463-467. [10]Iskander O,Courtot L,Tabchouri N,et al.Complete Pathological Response Following Radiochemotherapy for Locally Advanced Rectal Cancer:Short and Long-term Outcome[J].Anticancer Res,2019,39(9):5105-5113. [11]Lorimer PD,Motz BM,Kirks RC,et al.Pathologic Complete Response Rates After Neoadjuvant Treatment in Rectal Cancer:An Analysis of the National Cancer Database[J].Ann Surg Oncol,2017,24(8):2095-2103.[12]Maggiori L,Bretagnol F,Aslam MI,et al.Does pathologic response of rectal cancer influence postoperative morbidity after neoadjuvant radiochemotherapy and total mesorectalexcision[J]. Surgery,2014,155(3):468-475.[13]Silva GD,Berho M,Wexner S,et al.Histologic Analysis of the Irradiated Anal Sphincter[J].Diseases of the Colon&Rectum,2003,46(11):1492-1497.[14]Garcia-Aguilar J,Chow OS,Smith DD,et al.Effect of adding mFOLFOX6 after neoadjuvant chemoradiation in locally advanced rectal cancer:a multicentre,phase 2 trial[J].Lancet Oncol,2015,16(8):957-966.[15]Huntington CR,Boselli D,Symanowski J,et al.Optimal Timing of Surgical Resection After Radiation in Locally Advanced Rectal Adenocarcinoma:An Analysis of the National Cancer Database[J]. Ann Surg Oncol,2016,23(3):877-887.[16]van der Sluis FJ,Couwenberg AM,de Bock GH,et al.Population-based study of morbidity risk associated with pathological complete response after chemoradiotherapy for rectal cancer[J].Br J Surg,2020,107(1):131-139. [17]Zeng WG,Zhou ZX,Liang JW,et al.Impact of interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer on surgical and oncologic outcome[J].J Surg Oncol,2014,110(4):463-467.[18]Mihmanli M,Kabul Gürbulak E,AkgünIE,et al.Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer[J].World J Gastrointest Oncol,2016,8(9):695-706. [19]Sloothaak DA,Geijsen DE,van Leersum NJ,et al.Optimal time interval between neoadjuvant chemoradiotherapy and surgery for rectal cancer[J].Br J Surg,2013,100(7):933-939. [20]Karagkounis G,Thai L,Mace AG,et al.Prognostic Implications of Pathological Response to Neoadjuvant Chemoradiation in Pathologic StageⅢRectal Cancer[J].Ann Surg,2019,269(6):1117-1123. [21]Sun Z,Adam MA,Kim J,et al.Optimal Timing to Surgery after Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer[J].J Am Coll Surg,2016,222(4):367-374. [22]Petrelli F,Sgroi G,Sarti E,et al.Increasing the Interval Between Neoadjuvant Chemoradiotherapy and Surgery in Rectal Cancer:A Meta-analysis of Published Studies[J].Ann Surg,2016,263(3):458-464.

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更新日期/Last Update: 2020-05-15