【摘要】 背景与目的:新辅助治疗(放疗或放化疗)可使直肠癌的浸润深度和淋巴结转移状况都发生改变,而淋巴结转移情况对直肠癌的新辅助治疗方案的选择及后继治疗方案的选择有重要参考作用。本研究的目的是通过回顾性分析了解直肠癌新辅助治疗后影响淋巴结转移的相关因素。方法:收集2003年8月至2008年2月接受新辅助治疗及TME手术的中低位直肠癌病例93例,建立数据库。选择年龄、性别、肿瘤距肛缘距离、组织类型、新辅助治疗后T分期(ypT分期)、放疗前血清癌胚抗原(carcinoembryonic antigen,CEA)水平和CA19-9水平、放疗后血清CEA水平和CA19-9水平、放射剂量、接受含奥沙利铂方案的同期化疗与否、放射治疗与手术的时间间距等12项临床病理指标及治疗参数,用单因素分析和多因素分析的方法研究各因素对93例行新辅助治疗的直肠癌患者淋巴结转移情况的影响。结果:单因素分析显示,放疗后血清CEA水平、放射剂量、放射治疗与手术的时间间距、接受含奥沙利铂方案的同期化疗以及ypT分期是新辅助治疗后淋巴结转移情况(ypN分期)的相关因素。有序反应变量Logistic回归模型多因素分析显示,接受同期含奥沙利铂方案化疗及术后T分期是淋巴结转移的独立影响因素,相关系数分别为-0.481和0.503。结论:直肠癌新辅助治疗后ypT分期仍与ypN分期相关,ypT0-1患者淋巴结转移率低。含奥沙利铂的同期化疗可显著降低淋巴结转移的风险,有改善预后的潜在优势。更多还原

【Abstract】 Background and Objective:Neoadjuvant therapy(radiotherapy, RT or chemoradiotherapy,CRT) could change status of the invasion and lymph node metastasis of rectal cancer.The risk factors of lymph node metastasis in rectal cancers without neoadjuvant therapy have been well known, but those in rectal cancers treated with preoperative RT or CRT remain unclear.This study was to investigate the risk factors of lymph node metastasis in patients who underwent preoperative RT or CRT for rectal cancers.Methods:Clinical data of 93 patients underwent preoperative RT or CRT followed by total mesorectal exesion(TME) for locally advanced rectal adenocarcinoma from August, 2003 to February, 2008 were reviewed.Twelve clinicopathologic factors and treatment-related factors were studied with univariate and multivariate analyses.Results:Univariate analysis showed that post-RT or post-CRT serum carcinoembryonic antigen(CEA) level, radiation dose, time interval from RT or CRT to TME, concurrent chemotherapy with oxaliplatin-containing regimens, and infiltration extent to bowel wall after RT or CRT(ypT stage) were significantly associated with lymph node status after RT or CRT(ypN stage).Multivariate analysis showed that concurrent chemotherapy with oxaliplatin-containing regimens(r=-0.481, P<0.01) and ypT stage(r=0.503, P<0.01) were independent risk factors of ypN stage.Conclusions:Pathologic T stage is the most reliable predictor of lymph node stage in rectal cancer patients received preoperative RT or CRT.Oxaliplatin-containing regimens could significantly reduce the risks of lymph node metastases and potentially improve the prognosis.更多还原