新辅助放化疗对mrT3 期低位直肠癌患者不同浸润深度远期疗效的影响*

李智勇①; 林维文②; 官国先①; 蒋伟忠①; 刘 星①; 陈致奋①; 柯海林①; 段 青②

doi:10.3969/j.issn.1000-8179.20142117

新辅助放化疗对mrT3 期低位直肠癌患者不同浸润深度远期疗效的影响*

Long- term outcome of neoadjuvant chemoradiotherapy based on the depth of invasion in mrT3 low rectal cancer

摘要

摘要: 目的：探讨新辅助放化疗（neoadjuvant chemoradiotherapy ，CRT ）对cT 3 期低位直肠癌及其各亚分期预后的影响，进一步评估是否所有T 3 期低位直肠癌患者均应行CRT 。方法：对2008年1 月至2012年12月间福建医科大学附属协和医院结直肠外科收治的223 例cT 3 期低位直肠癌患者，按北美放射协会（RSNA）影像学分期标准回顾性进行亚分期，即根据高分辨率MRI 测量下肿瘤浸润直肠系膜的深度（depth of mesorectal invasion，DMI）分为mrT3a 期（DMI<5 mm），mrT3b 期（DMI 为5～10mm）和mrT3c 期（DMI>10mm），并根据是否行CRT 分为新辅助放化疗组（CRT 组，115 例）和未行新辅助放化疗组（nCRT组，108 例），比较两组患者及其
各亚分期（mrT3a、mrT3b、mrT3c）之间预后的差异。结果：对于整体mrT3 期，CRT 组和nCRT组的3 年无病生存率（78.2% vs . 71.9% ，P =0.608）和局部复发率（4.4% vs . 8.5% ，P = 0.120）无统计学差异。对于mrT3 各亚分期，CRT 组和nCRT组预后分别为：mrT3a：3 年无病生存率82.4% vs . 81.8%（P = 0.837）、局部复发率5.8% vs . 5.9%（P = 0.658）；mrT3b：3 年无病生存率84.4% vs . 42.4%（P = 0.032）、局部复发率0 vs . 18.2%（P = 0.014）；mrT3b、mrT3c：3 年无病生存率72.8% vs . 42.4%（P = 0.060）、局部复发率2.4% vs . 18.2%（P = 0.021）。单因素分析提示DMI 和环周切缘（circumferential resection margin ，CRM）是mrT3 期直肠癌患者3 年无病生存时间的影响因素，Cox 风险回归模型多因素分析提示CRM是独立影响因素（OR= 2.249，CI ：1.067～4.742，P = 0.033）。结论：CRT 能改善mrT3b、mrT3c 期低位直肠癌患者的预后，但可能无法改善mrT3a 且CRM阴性低位直肠癌患者的预后，对这部分患者可直接行手术治疗。

Abstract: Objective:To investigate the prognosis of cT 3 and the subgroups of low rectal cancer patients who underwent neoadju -vant chemoradiotherapy (CRT) and evaluate whether all patients with cT 3 low rectal cancer should undergo CRT. Methods:A total of 223 patients with cT 3 low rectal cancer treated in the Department of Colorectal Surgery of Fujian Medical University Union Hospital from January 2008to December 2012were divided into neoadjuvant chemoradiotherapy group (CRT group) ( 115 cases) and no neoad-juvant chemoradiotherapy group (nCRT group) ( 108 cases) according to whether the patients underwent CRT. Afterward, the patients were retrospectively divided into three subgroups (mrT3a, mrT 3b, and mrT3c) according to the proposed criteria of the Radiologic Soci -ety of North America (RSNA) by measuring the depth of mesorectal invasion (DMI) (DMI<5, DMI=5- 10, and DMI> 10mm). The prog-noses of the two groups and their subgroups were compared. Results:The CRT and nCRT groups revealed no significant differences in the 3-year disease-free survival rate and the local recurrence rate for all the mrT 3 patients ( 78.2% vs . 71.9%,P =0.608; 4.4% vs . 8.5%,P =0.120) and mrT3a patients ( 82.4% vs . 81.8%,P =0.837; 5.8% vs . 5.9%,P =0.658). On the contrary, for the mrT 3b patients, the CRT and nCRT groups revealed significant differences in the3-year disease-free survival rate (84.4% vs . 42.4%,P =0.032) and local recurrence rate (0.0% vs . 18.2%,P =0.014). For the mrT 3b,c patients, the CRT and nCRT groups revealed no significant difference in the 3-year dis -ease-free survival rate ( 72.8% vs . 42.4%,P =0.060) but revealed a significant difference in the local recurrence rate ( 2.4% vs . 18.2 %,P =0.021). COX regression analysis was utilized for 3-year disease-free survival, DMI and circumferential resection margin (CRM) were significant in the univariate analysis. Additionally, the multivariate analysis indicated that CRM is an independent impact factor (OR= 2.249, CI 1.067- 4.742, P =0.033). Conclusion:CRT can improve the prognosis of patients with mrT3b,c low rectal cancer but may not significantly influence the prognosis of patients with mrT3a and CRM-negative low rectal cancer; surgical treatment can be performed in these patients without CRT.

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