Clinical efficacy and prognostic factors of neoadjuvant chemoradiotherapy for locally advanced low and middle rectal cancer
10.3760/cma.j.issn.1004-4221.2018.12.007
- VernacularTitle:局部进展期中低位直肠癌新辅助放化疗临床疗效及预后影响因素分析
- Author:
Yan LIU
1
;
Yin LYU
;
Yanrong LU
;
Nan XIAO
;
Wanyan WU
;
Jinrong ZHANG
Author Information
1. 新疆医科大学第三临床医学院(附属肿瘤医院)胸腹放疗科
- Keywords:
Rectal neoplasms/chemoradiotherapy;
Prognosis
- From:
Chinese Journal of Radiation Oncology
2018;27(12):1066-1071
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical efficacy of neoadjuvant chemoradiotherapy in the treatment of locally advanced low and middle rectal cancer,and evaluate the effect of related clinical factors upon the long-term survival. Methods Clinical data of 101 patients with locally advanced low and middle rectal cancer admitted to our hospital from January 1,2010 to December 31,2014 were collected. All patients completed the preoperative intensity-modulated radiation therapy DT45-50. 4 Gy,synchronized with oxaliplatin+capecitabine/5-fluorouracil or single drug capecitabine chemotherapy,and total mesorectal excision) was performed 4-13 weeks after the end of the neoadjuvant therapy. The short-term efficacy and long-term prognosis of these patients were evaluated. Kaplan-Meier method was used for survival analysis,and Cox’s regression model for multivariate analysis. Results The total sphincter preservation rate was 53. 5%.The decrease rates of T,N staging and TNM total staging were 73. 26%,67. 32% and 72. 3%,respectively. The pathological complete response ( pCR) rate was 16. 8%.The median follow-up time was 41 months. The 3-year overall survival (OS), desease-free survival (DFS),local recurrence and distant metastases rates were 82. 2%,80. 7%,7. 2% and 12. 1%,respectively. The single factor analysis demonstrated that ypT and ypN stages were the risk factors affecting the 3-year OS,DFS anddistant metastases ( all P＜0. 05).Multivariate analysis revealed that ypT stage was an independent factor affecting the 3-year OS,and ypT and ypN stages were the independent factors of the 3-year DFS ( all P＜ 0. 05 ). ConclusionsNeoadjuvant chemoradiotherapy combined with TME in the treatment of locally advanced middle and low rectal cancer can partially decrease the tumor staging,enhance the sphincter preservation rate and improve long-term clinical prognosis. Both ypT and ypN stages are correlated with the clinical prognosis of patients.
