局部进展期中高位和中低位直肠癌术前放化疗的疗效和安全性比较。

Comparison of efficacy and safety of preoperative Chemoradiotherapy in locally advanced upper and middle/lower rectal cancer.

机构信息

Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Department of Radiation Oncology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

Radiat Oncol. 2018 Mar 27;13(1):53. doi: 10.1186/s13014-018-0987-0.

BACKGROUND

We aimed to explore the efficacy and safety profile of preoperative neoadjuvant chemoradiation (NACRT) in locally advanced rectal cancer (LARC) in upper rectum versus middle/lower rectum.

METHODS

The study included 173 patients with stage II or III (T2-4b, N0-2b) LARC who underwent NACRT followed by total mesorectal excision (TME) between January 2011 and October 2016. Cox regression, log-rank test, and Kaplan-Meier curves were calculated.

RESULTS

Among the 173 patients, 58 had lesions in the upper rectum and 115 patients had lesions in middle/lower rectum. In a median follow-up of 35 months (range, 6-73 months), the 5-year disease-free survival (DFS) and overall survival (OS) were 84% and 88% for the patients with upper rectal cancer and 77% and 68% for those with middle/lower rectal cancer (P = 0.251 and P = 0.058, respectively). The 5-year DFS (P = 0.012) and OS (P = 0.003) were better in the NACRT responders [tumor regression grade (TRG) 0 or 1] compared with nonresponders (TRG 2 or 3). The independent prognostic factor of favorable response to NACRT was the FOLFOX regimen (P = 0.004).

CONCLUSIONS

Patients with LARC in the upper rectum who underwent NACRT followed by TME had similar DFS and a trend toward longer OS, compared with those who had middle/lower rectal lesions. Furthermore, FOLFOX may yield superior results than fluoropyrimidine based regimen during NACRT. NACRT might be an alternative option for patients with LARC in the upper rectum as it has a favorable pathological complete response rate and comparable clinical outcomes when compared with patients with LARC in middle/lower rectum.

背景

我们旨在探索术前新辅助放化疗（NACRT）在治疗高位直肠癌（LARC）与中低位直肠癌中的疗效和安全性。

方法

本研究纳入了 173 例 2011 年 1 月至 2016 年 10 月期间接受 NACRT 联合全直肠系膜切除术（TME）治疗的 II 期或 III 期（T2-4b，N0-2b）LARC 患者。采用 Cox 回归、Log-rank 检验和 Kaplan-Meier 曲线进行分析。

结果

在 173 例患者中，58 例患者的病灶位于高位直肠，115 例患者的病灶位于中低位直肠。中位随访 35 个月（范围 6-73 个月）后，高位直肠癌患者的 5 年无病生存率（DFS）和总生存率（OS）分别为 84%和 88%，中低位直肠癌患者的 5 年 DFS 和 OS 分别为 77%和 68%（P=0.251 和 P=0.058）。NACRT 应答者（肿瘤消退分级[TRG]0 或 1）的 5 年 DFS（P=0.012）和 OS（P=0.003）均优于无应答者（TRG 2 或 3）。NACRT 应答的独立预后因素是 FOLFOX 方案（P=0.004）。

结论

与中低位直肠病变患者相比，接受 NACRT 联合 TME 治疗的高位 LARC 患者的 DFS 相似，OS 有延长趋势。此外，在 NACRT 期间，FOLFOX 方案可能比氟嘧啶类方案产生更好的效果。与中低位直肠 LARC 患者相比，NACRT 可能是高位直肠 LARC 患者的一种替代选择，因为它具有较高的病理完全缓解率和可比的临床结局。