肿瘤体积对局部进展期直肠癌预后的影响

The effect of tumor volume on the prognosis of locally advanced rectal cancer

    摘要
  • 摘要:
      目的  探讨肿瘤体积（gross tumor volume，GTV）对接受新辅助放化疗（neoadjuvant chemoradiotherapy，NCRT）和全直肠系膜切除术（total mesorectal excision，TME）后，局部进展期直肠癌（locally advanced rectal cancer，LARC）患者的预后影响。
      方法  回顾性分析2011年1月至2016年9月湖南省肿瘤医院收治的128例初治直肠癌患者的临床资料，均接受术前同步放化疗+TME。采用受试者工作特征曲线（receiver-operating characteristic，ROC）分析GTV截点值，用Kaplan-Meier生存分析和Cox比例风险回归模型进行预后分析。
      结果  行NCRT后T分期降期率为58.6%，N分期降期率为69.5%，总体降期率为77.3%，病理完全缓解（pathologi-cal complete response，pCR）率为16.4%，总体保肛率为57.03%。GTV的截点为79.31 mL，GTV ≥ 79.31 mL与GTV < 79.31 mL患者的3年总生存率（overall survival，OS）、无病生存率（disease-free survival，DFS）、无局部复发生存率（local relapse free survival，LRFS）、无远处转移生存率（distant-metastasis-free survival，DMFS）有显著性差异。GTV与MRI-T分期（ρ=0.236，P=0.007）、T分期变化（ρ=0.229，P=0.009）、TNM分期变化（ρ=0.219，P=0.013）及肿瘤退缩分级（tumor regression grade，TRG）（ρ=0.517，P < 0.001）相关，与MRI-T分期、MRI-N分期及N分期变化无关。
      结论  GTV与LARC的局部复发、远处转移密切相关，是预后因素之一；肿瘤体积与治疗前T分期、新辅助治疗后的T分期变化、TNM分期变化及TRG相关，与治疗前N分期及N分期变化无关。

     

    Abstract:
      Objective  To evaluated the prognostic effect of tumor volume in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME).
      Methods  This was a retrospective analysis of 128 patients with newly diagnosed rectal cancer who received preoperative concurrent chemoradiation plus TME from January 2011 to September 2016 in Hunan Cancer Hospital. The receiver-operating characteristic (ROC) curve was used to analyze the gross tumor volume (GTV) cut-off point. Prognostic analysis was performed using Kaplan-Meier, Log-rank, and Cox regression models.
      Results  After NCRT, T-stage declined 58.6%, N-stage declined 69.5%, and the overall TNM stage declined 77.3%. After NCRT, the pathological complete response (pCR) rate was 16.4% and the anus-protection rate was 57.03%. The GTV cut-off point was 79.31 mL. There were significant differences in OS, DFS, LRFS and DMFS between patients with GTV ≥ 79.31 mL and patients with GTV < 79.31 mL over three years. GTV was significantly related to MRI-T staging (ρ=0.236; P=0.007), T downstaging (ρ=0.229; P=0.009), TNM downstaging (ρ=0.219; P=0.013), and tumor regression grade (TRG) (ρ=0.517; P < 0.001); however, GTV was not significantly related to MRI-N staging and N downstaging.
      Conclusions  GTV is closely related to local recurrence and distant metastasis of LARC, and is an important prognostic factor. Tumor volume was significantly related to pretreatment MRI-T staging, T downstaging, TNM downstaging after NCRT, and TRG, but not to pretreatment MRI-N staging and N downstaging.

     

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