摘要
目的探讨肿瘤环腔占比与局部进展期直肠癌新辅助治疗疗效和远期预后的关系。方法回顾性分析2018年1月至2022年1月间于北京协和医院基本外科诊治的451例局部进展期直肠癌患者的临床资料。根据直肠核磁界定的肿瘤环腔占比值,将研究对象分为高环腔占比组(≥2/3周,270例)和低环腔占比组(<2/3周,181例),主要结局指标是3年无病生存率。比较两组患者的临床病理特征、近期疗效及远期生存预后。结果与低环腔占比组患者相比,高环腔占比组患者的肿瘤矢状径更大[(4.7±1.7)cm和(3.6±1.4)cm,P<0.001],mrT4分期比例(37.8%和13.3%,P<0.001)、直肠周围筋膜阳性率(54.1%和29.8%,P<0.001)和肠壁外血管侵犯阳性率(55.6%和38.1%,P<0.001)更高,高环腔占比组以pT3~4期(占比分别为46.7%和30.9%,P=0.002)、Ⅱ期/Ⅲ期(占比分别为15.9%和13.3%,P=0.003)为主,病理完全缓解率更低(22.2%和33.1%,P=0.010),肿瘤退缩程度(CAP 0~1级占比)更差(48.9%和60.8%,P=0.013),神经侵犯率更高(11.5%和5.5%,P=0.031)。中位随访40个月,局部复发11例(2.4%),远处转移48例(10.6%)。低环腔占比组与高环腔占比组的复发率分别为2.2%和2.6%,远处转移率分别为7.7%和12.6%,两组差异均无统计学意义(P值分别为0.957和0.096)。高环腔占比组患者3年无病生存率低于低环腔占比组(84.4%和92.4%,P=0.014)。结论肿瘤环腔占比与肿瘤负荷密切相关,可判断肿瘤对新辅助放化疗的反应性,且与远期预后密切相关。对于环腔占比超过2/3周的直肠癌患者,需采取强化治疗措施,以改善其远期预后。
Objective To detect the association of tumor circumferential involvement range(CIR)with neoadjuvant chemoradiotherapy(NCRT)efficacy and long-term survival outcomes in locally advanced rectal cancer(LARC)patients.MethodsClinical data of 451 patients admitted to our hospital from January,2018 to January,2022 were retrospectively collected.According to the CIRs as determined by rectal magnetic resonance imaging,patients were divided into the High group(≥2/3 cycle,270 patients)and the Low group(<2/3 cycle,181 patients).The primary outcome was three-year disease-free survival.The baseline characteristics,pathological features,and survival outcomes were compared.ResultsCompared to patients in the Low group,patients in the High group exhibited significantly larger tumor vertical diameters[(4.7±1.7)vs.(3.6±1.4)cm,P<0.001],higher rates of mrT4 stage(37.8%vs.13.2%,P<0.001),and higher rates of positive mesorectal fascia(54.1%vs.29.8%,P<0.001)and extramural vascular invasion(55.6%vs.38.1%,P<0.001).Patients in the High group were mainly pT3-4 stages(46.7%vs.30.9%,P=0.002),with significantly lower rates of pathological complete response(22.2%vs.33.1%,P=0.010),poorer tumor regression grades(48.9%vs.60.8%,P=0.013),and higher rates of positive peripheral nerve invasion(11.5%vs.5.5%,P=0.031),as compared to patients in the Low group.The median follow-up time was 40 months.About 11(2.4%)and 48 patients(10.6%)experienced tumor local recurrence and distant metastasis,respectively.The recurrence rates were 2.2%and 2.6%,and the distant metastasis rates were 7.7%and 12.6%,respectively,in the Low group and the High group,with no statistical significance(P=0.957,P=0.096).The three-year disease-free survival in the High group was significantly lower than that in the Low group(84.4%vs.92.4%,P=0.014).ConclusionsThe CIR is closely related to tumor burden,which can judge tumor response to NCRT,and is negatively related to survival prognosis.For patients who have more than a 2/3 cycle of CIR,intensified or consolidated treatments may be required to improve survival outcomes.
作者
李干斌
邱小原
张潇
徐徕
牛备战
张冠南
陆君阳
吴斌
肖毅
林国乐
Li Ganbin;Qiu Xiaoyuan;Zhang Xiao;Xu Lai;Niu Beizhan;Zhang Guannan;Lu Junyang;Wu Bin;Xiao Yi;Lin Guole(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100731,China)
出处
《中华肿瘤杂志》
北大核心
2025年第8期750-755,共6页
Chinese Journal of Oncology
基金
北京协和医院中央高水平医院临床科研专项(2022-PUMCH-C-005)。
关键词
直肠肿瘤
局部进展期
新辅助治疗
肿瘤环腔占比
疗效
Rectal neoplasms
Locally advanced
Neoadjuvant therapy
Circumferential occupation range
Efficacy
