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新辅助放化疗及全直肠系膜切除术后MRI评估局部晚期直肠癌无进展生存期

[Evaluation of progression-free survival for locally advanced rectal cancer by MRI after neoadjuvant chemoradiotherapy and total mesorectal excision].

作者信息

Zhang J X, Yang Z, Fan P, Zhang J J, Xin L, Hou L N, Du X S, Yang X T

机构信息

MRI/CT Unit, Shanxi Cancer Hospital, the Third People's Hospital of Shanxi Province, Taiyuan 030013, China.

出版信息

Zhonghua Zhong Liu Za Zhi. 2018 Feb 23;40(2):121-126. doi: 10.3760/cma.j.issn.0253-3766.2018.02.008.

Abstract

To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery. A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival. Among the 95 cases, 5 cases occured local recurrence, 21 cases developed, 3 cases including both locally recurrence and distant metastasis, 19 died and 47 had no recurrence or metastasis at the last of follow-up. Univariant analysis showed that MRI signs before chemoradiation, namely, mr circumferential resection margin, mr levator ani muscle invasion, mr lymphatic vessel invasion, mr tumor deposition and postoperative pathological parameters, yp circumferential resection margin, yp lymphatic vessel invasion were related to PFS (<0.05). Multivariate analysis of Cox proportional hazard model showed that mr lymphatic vessel invasion and mr tumor deposition were independent factors for PFS (=2.774 and 3.029, <0.05). Lymphatic vessel invasion and tumor deposition on MRI are independent prognostic factors for progression free survival of locally advanced rectal cancer after neoadjuvant chemoradiotherapy and TME surgery. To some extent, MRI signs can assess local recurrence and distant metastasis in locally advanced rectal cancer patients after neoadjuvant chemoradiotherapy and mesorectal excision.

摘要

评估新辅助放化疗及后续全直肠系膜切除术后,MRI特征和病理参数对局部晚期直肠癌局部复发、转移及无进展生存期(PFS)的预测价值。对95例新辅助放化疗后接受全直肠系膜切除术的局部晚期直肠腺癌患者进行回顾性分析。进行单因素和多因素分析,以评估放化疗前MRI特征和术后病理参数对无进展生存期的预测价值。95例患者中,5例发生局部复发,21例出现转移,3例同时发生局部复发和远处转移,19例死亡,47例在末次随访时无复发或转移。单因素分析显示,放化疗前的MRI征象,即mr环周切缘、mr肛提肌侵犯、mr淋巴管侵犯、mr肿瘤沉积以及术后病理参数yp环周切缘、yp淋巴管侵犯与PFS相关(<0.05)。Cox比例风险模型多因素分析显示,mr淋巴管侵犯和mr肿瘤沉积是PFS的独立因素(=2.774和3.029,<0.05)。MRI上的淋巴管侵犯和肿瘤沉积是新辅助放化疗及全直肠系膜切除术后局部晚期直肠癌无进展生存期的独立预后因素。在一定程度上,MRI征象可评估新辅助放化疗及直肠系膜切除术后局部晚期直肠癌患者的局部复发和远处转移情况。

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