II期和III期直肠腺癌辅助和新辅助放化疗中的贫血与长期预后：弗莱堡经验（1989 - 2002年）

Anemia and long-term outcome in adjuvant and neoadjuvant radiochemotherapy of stage II and III rectal adenocarcinoma: the Freiburg experience (1989-2002).

作者信息

Weissenberger Christian, Geissler Michael, Otto Florian, Barke Annette, Henne Karl, von Plehn Georg, Rein Alex, Muller Christine, Bartelt Susanne, Henke Michael

机构信息

Department of Radiotherapy, University Hospital of Freiburg, 79106 Freiburg, Germany.

出版信息

World J Gastroenterol. 2006 Mar 28;12(12):1849-58. doi: 10.3748/wjg.v12.i12.1849.

DOI:10.3748/wjg.v12.i12.1849

PMID:16609990

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4087509/

Abstract

AIM

To evaluate the long-term outcome of standard 5-FU based adjuvant or neoadjuvant radiochemotherapy and to identify the predictive factors, especially anemia before and after radiotherapy as well as hemoglobin increase or decrease during radiotherapy.

METHODS

Two hundred and eighty-six patients with Union International Contre Cancer (UICC) stage II and III rectal adenocarcinomas, who underwent resection by conventional surgical techniques (low anterior or abdominoperineal resection), received either postoperative (n=233) or preoperative (n=53) radiochemotherapy from January 1989 until July 2002. Overall survival (OAS), cancer-specific survival (CSS), disease-free survival (DFS), local-relapse-free (LRS) and distant-relapse-free survival (DRS) were evaluated using Kaplan-Meier, Log-rank test and Cox's proportional hazards as statistical methods. Multivariate analysis was used to identify prognostic factors. Median follow-up time was 8 years.

RESULTS

Anemia before radiochemotherapy was an independent prognostic factor for improved DFS (risk ratio 0.76, P=0.04) as well as stage, grading, R status (free radial margins), type of surgery, carcinoembryonic antigen (CEA) levels, and gender. The univariate analysis revealed that anemia was associated with impaired LRS (better local control) but with improved DFS. In contrast, hemoglobin decrease during radiotherapy was an independent risk factor for DFS (risk ratio 1.97, P=0.04). During radiotherapy, only 30.8% of R0-resected patients suffered from hemoglobin decrease compared to 55.6% if R1/2 resection was performed (P=0.04). The 5-year OAS, CSS, DFS, LRS and DRS were 47.0%, 60.0%, 41.4%, 67.2%, and 84.3%, respectively. Significant differences between preoperative and postoperative radiochemotherapy were not found.

CONCLUSION

Anemia before radiochemotherapy and hemoglobin decrease during radiotherapy have no predictive value for the outcome of rectal cancer. Stage, grading, R status (free radial margins), type of surgery, CEA levels, and gender have predictive value for the outcome of rectal cancer.

摘要

目的

评估基于标准5-氟尿嘧啶的辅助或新辅助放化疗的长期疗效，并确定预测因素，尤其是放疗前后的贫血情况以及放疗期间血红蛋白的增减情况。

方法

286例国际抗癌联盟（UICC）II期和III期直肠腺癌患者，采用传统手术技术（低位前切除术或腹会阴联合切除术）进行切除，于1989年1月至2002年7月接受术后（n = 233）或术前（n = 53）放化疗。采用Kaplan-Meier法、Log-rank检验和Cox比例风险模型作为统计方法评估总生存期（OAS）、癌症特异性生存期（CSS）、无病生存期（DFS）、局部无复发生存期（LRS）和远处无复发生存期（DRS）。采用多因素分析确定预后因素。中位随访时间为8年。

结果

放化疗前贫血是DFS改善的独立预后因素（风险比0.76，P = 0.04），同时也是分期、分级、R状态（切缘阴性）、手术类型、癌胚抗原（CEA）水平和性别的独立预后因素。单因素分析显示，贫血与LRS受损（更好的局部控制）相关，但与DFS改善相关。相反，放疗期间血红蛋白下降是DFS的独立危险因素（风险比1.97，P = 0.04）。放疗期间，R0切除患者中只有30.8%的患者血红蛋白下降，而R1/2切除患者中这一比例为55.6%（P = 0.04）。5年OAS、CSS、DFS、LRS和DRS分别为47.0%、60.0%、41.4%、67.2%和84.3%。未发现术前和术后放化疗之间存在显著差异。