广州医科大学学报

目的:分析同步放化疗对局部晚期直肠癌患者预后的影响。方法:研究对象为本院自2014年1月～2019年6月收治的112例局部晚期直肠癌患者;所有患者均行同步放化疗,记录同步放化疗疗效、不良反应发生情况,并绘制Kaplan-Meier生存曲线分析累积无复发生存率及生存率。结果:112例局部晚期直肠癌患者经MRI或CT影像学明确客观缓解率为78.57%(88/112),临床分期T0期20(17.86%)例、T1期3(2.68%)例、T2期24(21.43%)例、T3期61(54.46%)例、T4期4(3.57%)例;N0期69(61.61%)例、N1期24(21.43%)例、N2期19(16.96%)例;同步放化疗期间未见Ⅳ级不良反应现象,其中骨髓抑制、恶心呕吐、放射性肠炎、放射性皮炎、手足综合征、放射性膀胱炎发生率分别为100.00%、93.75%、96.43%、5.36%、8.04%、8.04%;腹会阴联合切除术/Mile’s术占比33.04%、直肠癌前切除术/Dixon术占比66.96%;术后病理pCR占比13.39%;局部复发、远处转移及死亡率分别为8.04%、25.89%、29.46%,累积无复发生存率、累积生存率分别为91.96%、70.54%。结论:同步放化疗是治疗局部晚期直肠癌的有效综合性治疗方案,值得临床重视。

Objective:To investigate the effects of concurrent chemoradiotherapy on the prognosis of patients with locally advanced rectal cancer.Methods:A total of 112 patients with locally advanced rectal cancer admitted to our hospital between January 2014 and June 2019 were included as the subjects. All patients underwent concurrent chemoradiotherapy. Efficacy of concurrent chemoradiotherapy and adverse reactions were recorded.Kaplan-Meier survival curve was generated to analyze the cumulative recurrence-free survival rate and cumulative survival rate.Results:The objective remission rate as confirmed by MRI and CT in these 112 patients with locally advanced rectal cancer was 78.57%(88/112). There were 20 cases(17.86%)in clinical stage T0,3(2.68%)in stage T1,24(21.43%)in stage T2,61(54.46%)in stage T3,4(3.57%)in stage T4,69(61.61%)in stage N0,24(21.43%)in stage N1 and 19(16.96%)in stage N2. There was no grade IV adverse reaction during concurrent chemoradiotherapy. The incidence rates of myelosuppression,nausea and vomiting,radiation enteritis,radiation dermatitis,hand-foot syndrome and radiation cystitis were 100.00%,93.75%,96.43%,5.36%,8.04%and 8.04%,respectively. The proportions of abdominal-perineal resection/Mile's surgery,anterior resection of Dixon surgery and postoperative pathological pCR were 33.04%,66.96% and 13.39%,respectively.The rates of local recurrence,distant metastasis and mortality were 8.94%,25.89% and 29.46%,respectively. The cumulative recurrence-free survival rate and cumulative survival rate were 91.96% and 70.54%,respectively.Conclusion:Concurrent chemoradiotherapy is an effective comprehensive treatment for locally advanced rectal cancer,which is worthy of clinical attention.