高级搜索

不同新辅助治疗方案对直肠癌患者TRG、手术并发症及LARS的影响

陈功勤, 张洋, 郭慧, 欧阳洋

陈功勤, 张洋, 郭慧, 欧阳洋. 不同新辅助治疗方案对直肠癌患者TRG、手术并发症及LARS的影响[J]. 肿瘤防治研究, 2021, 48(12): 1108-1112. DOI: 10.3971/j.issn.1000-8578.2021.21.0421
引用本文: 陈功勤, 张洋, 郭慧, 欧阳洋. 不同新辅助治疗方案对直肠癌患者TRG、手术并发症及LARS的影响[J]. 肿瘤防治研究, 2021, 48(12): 1108-1112. DOI: 10.3971/j.issn.1000-8578.2021.21.0421
CHEN Gongqin, ZHANG Yang, GUO Hui, OUYANG Yang. Effect of Neoadjuvant Treatment on TRG, Surgical Complications and LARS in Patients with Rectal Cancer[J]. Cancer Research on Prevention and Treatment, 2021, 48(12): 1108-1112. DOI: 10.3971/j.issn.1000-8578.2021.21.0421
Citation: CHEN Gongqin, ZHANG Yang, GUO Hui, OUYANG Yang. Effect of Neoadjuvant Treatment on TRG, Surgical Complications and LARS in Patients with Rectal Cancer[J]. Cancer Research on Prevention and Treatment, 2021, 48(12): 1108-1112. DOI: 10.3971/j.issn.1000-8578.2021.21.0421

不同新辅助治疗方案对直肠癌患者TRG、手术并发症及LARS的影响

基金项目: 

吴阶平医学基金会临床科研专项资助基金 320.6750.17516

详细信息
    作者简介:

    陈功勤(1991-),男,硕士,医师,主要从事结直肠的研究

    通信作者:

    张洋(1981-),男,博士,副教授,主要从事结直肠研究,E-mail: 793364850@qq.com

  • 中图分类号: R735.3+7

Effect of Neoadjuvant Treatment on TRG, Surgical Complications and LARS in Patients with Rectal Cancer

Funding: 

Wu Jieping Medical Foundation 320.6750.17516

More Information
  • 摘要:
    目的 

    研究不同新辅助治疗方案对直肠癌患者肿瘤消退、手术并发症和低位前切除术综合征(LARS)的影响。

    方法 

    选取新辅助治疗的直肠癌患者127名为研究对象。长程同步放化疗组42例,短程放疗+化疗组39例,化疗46例。收集患者病理学结果、临床资料及随访结果。选取其中可能对于直肠癌术后肿瘤退缩、手术并发症及低位前切除综合征产生影响的因素进行Logistic回归分析,多组单项有序资料使用Ridit分析。

    结果 

    三组患者pCR率分别为:28.51%、10.3%和8.6%。三组发生围手术期并发症患者分别为14例(33.33%)、9例(23.07%)、10例(21.74%)。91例纳入研究,出现LARS症状者49例(53.84%),其中重度LARS患者17例(18.68%)。三组出现LARS症状者分别为27例(重度13例)、12例(重度2例)和9例(重度2例)。

    结论 

    三种新辅助治疗方案均有较好的手术安全性;长程同步放化疗和短程放疗+化疗在肿瘤退缩方面均有优势,但长程同步放化疗更容易引起LARS症状,影响患者生活质量,在临床治疗方案选择上需要综合考虑。

     

    Abstract:
    Objective 

    To investigate the effects of different neoadjuvant treatments on tumor regression, surgical complications and low anterior resection syndrome (LARS) in patients with rectal cancer.

    Methods 

    We included 127 patients with rectal cancer receiving neoadjuvant treatments, and they were divided into long-term concurrent chemoradiotherapy group (n=42), short-term radiotherapy+chemotherapy group (n=39) and chemotherapy group (n=46). The pathological results, clinical data and follow-up results were collected. The factors that may affect tumor regression, surgical complications and low anterior resection syndrome after rectal cancer surgery were statistically analyzed and concluded.

    Results 

    The pCR rates were 28.51%, 10.3% and 8.6% in long-term concurrent chemoradiotherapy group, short-term radiotherapy+chemotherapy group and chemotherapy group, respectively. There were 14 (33.33%), 9 (23.07%) and 10 (21.74%) patients with perioperative complications in three groups, respectively. A total of 91 patients were enrolled in the LARS study. There were 49 (53.84%) cases with LARS symptoms, including 17 (18.68%) cases with severe LARS. In three groups, there were 27 cases (including 13 cases of severe LARS), 12 cases (including 2 cases of severe LARS) and 9 cases (including 2 cases of severe LARS) of LARS symptoms, respectively.

    Conclusion 

    Three neoadjuvant treatments have good surgical safety. Long-term concurrent chemoradiotherapy and short-term radiotherapy+chemotherapy have advantages in tumor regression, but the former is more likely to cause LARS symptoms and affect the quality of life.Comprehensive consideration is needed in the choice of clinical treatments.

     

  • Competing interests: The authors declare that they have no competing interests.
    作者贡献:
    陈功勤:资料收集及论文撰写
    张洋:论文修改
    郭慧:数据统计分析及随访
    欧阳洋:论文指导
  • 表  1   三组直肠癌患者基础资料对比

    Table  1   Comparison of basic data among three groups of rectal cancer patients

    下载: 导出CSV

    表  2   三组直肠癌患者肿瘤退缩情况

    Table  2   Tumor regression grade (TRG) status of three groups of rectal cancer patients

    下载: 导出CSV

    表  3   直肠癌术后TRG的多因素分析

    Table  3   Multivariate analysis of postoperative TRG of rectal cancer

    下载: 导出CSV

    表  4   三组直肠癌患者术后并发症

    Table  4   Postoperative complications of three groups of rectal cancer patients

    下载: 导出CSV

    表  5   直肠癌患者LARS的多因素logistic回归分析结果

    Table  5   Multivariate logistic regression analysis results of LARS in rectal cancer patients

    下载: 导出CSV
  • [1]

    Ferlay J, Colombet M, Soerjomataram I, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods[J]. Int J Cancer, 2019, 144(8): 1941-1953. doi: 10.1002/ijc.31937

    [2] 曹毛毛, 陈万青. 中国恶性肿瘤流行情况及防控现状[J]. 中国肿瘤临床, 2019, 46(3): 145-149. doi: 10.3969/j.issn.1000-8179.2019.03.283

    Cao MM, Chen WQ. Epidemiology of cancer in China and the current status of prevention and control[J]. Zhongguo Zhong Liu Lin Chuang, 2019, 46(3): 145-149. doi: 10.3969/j.issn.1000-8179.2019.03.283

    [3]

    Bolton WS, Chapman SJ, Corrigan N, et al. The Incidence of Low Anterior Resection Syndrome as Assessed in an International Randomized Controlled Trial (MRC/NIHR ROLARR)[J]. Ann Surg, 2020. Online ahead of print.

    [4] 中华医学会外科学分会腹腔镜与内镜外科学组, 中华医学会外科学分会结直肠外科学组, 中国医师协会外科医师分会结直肠外科医师委员会, 等. 腹腔镜结直肠癌根治术操作指南(2018版)[J]. 中华消化外科杂志, 2018, 17(9): 877-885.

    Laparoscopic & Endoscopic Surgery Group, Branch of Surgery, Chinese Medical Association; Colorectal Surgery Group, Branch of Surgery, Chinese Medical Association; Chinese Society of Colon and Rectal Surgeons, Chinese Medical Doctor Association; Laparoscopic Surgery Group, Chinese Society of Colorectal Cancer, China Anti-cancer Association. Guideline for operative procedure of laparoscopic radical resection of colorectal cancer (2018 edition)[J]. Zhonghua Xiao Hua Wai Ke Za Zhi, 2018, 17(9): 877-885.

    [5] 董功航, 兰平, 汪建平. 中低位直肠癌术前放化疗现状[J]. 中国实用外科杂志, 2008, 28(2): 149-150. doi: 10.3321/j.issn:1005-2208.2008.02.025

    Dong GH, LanP, Wang JP. Current status of preoperative radiotherapy and chemotherapy for middle and low rectal cancer[J]. Chinese Journal of Practical Surgery, 2008, 28(2): 149-150. doi: 10.3321/j.issn:1005-2208.2008.02.025

    [6] 左芦根, 葛思堂, 王迅, 等. 腹腔镜直肠癌保肛根治术后低位前切除综合征的转归及其影响因素分析[J]. 中华胃肠外科杂志, 2019, 22(6): 573-578. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202101005.htm

    Zuo LG, Ge ST, Wang X, et al. Analysis on prognosis and influencing factors of postoperative low anterior resection syndrome for rectal cancer patients undergoing laparoscopic anus-preserving radical resection[J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2019, 22(6): 573-578. https://www.cnki.com.cn/Article/CJFDTOTAL-GCBZ202101005.htm

    [7]

    Sauer R, Liersch T, Merkel S, et al. Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase Ⅲ trial after a median follow-up of 11 years[J]. J Clin Oncol, 2012, 30(16): 1926-1933. doi: 10.1200/JCO.2011.40.1836

    [8]

    Trakarnsanga A, Gonen M, Shia J, et al. Comparison of tumor regression grade systems for locally advanced rectal cancer after multimodality treatment[J]. J Natl Cancer Inst, 2014, 106(10): dju248. http://pubmedcentralcanada.ca/pmcc/articles/PMC4271114/

    [9]

    Beddy D, Hyland JMP, Winter DC, et al. A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy[J]. Ann Surg Oncol, 2008, 15(12): 3471-3477. doi: 10.1245/s10434-008-0149-y

    [10]

    Andreyev J. Gastrointestinal complications of pelvic radiotherapy: are they of any importance?[J]. Gut, 2005, 54(8): 1051-1054. doi: 10.1136/gut.2004.062596

    [11]

    Park JS, Choi GS, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group[J]. Ann Surg, 2013, 257(4): 665-671. doi: 10.1097/SLA.0b013e31827b8ed9

    [12] 徐谊, 赵晓牧, 孙武青, 等. 直肠癌低位前切除术后吻合口瘘发生相关因素分析[J]. 首都医科大学学报, 2017, 38(5): 727-732. doi: 10.3969/j.issn.1006-7795.2017.05.018

    Xu Y, Zhao XM, Sun WQ, et al. Risk factors on anastomotic leakage after low anterior resection of rectal cancer[J]. Shou Du Yi Ke Da Xue Xue Bao, 2017, 38(5): 727-732. doi: 10.3969/j.issn.1006-7795.2017.05.018

    [13]

    Wang Q, Huang Y, Xiong W, et al. Preoperative short-course radiotherapy (5×5 Gy) with delayed surgery versus preoperative long-course radiotherapy for locally resectable rectal cancer: a meta-analysis[J]. Int J Colorectal Dis, 2019, 34(12): 2171-2183. doi: 10.1007/s00384-019-03433-9

    [14]

    Bujko K, Nowacki MP, Nasierowska-Guttmejer A, et al. Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer[J]. Br J Surg, 2006, 93(10): 1215-1223. doi: 10.1002/bjs.5506

    [15]

    Bujko K, Nowacki MP, Kepka L, et al. Postoperative complications in patients irradiated pre-operatively for rectal cancer: report of a randomised trial comparing short-term radiotherapy vs chemoradiation[J]. Colorectal Dis, 2005, 7(4): 410-416. doi: 10.1111/j.1463-1318.2005.00796.x

    [16]

    Bujko K, Wyrwicz L, Rutkowski A, et al. Long-course oxaliplatin-based preoperative chemoradiation versus 5×5 Gy and consolidation chemotherapy for cT4 or fixed cT3 rectal cancer: results of a randomized phase Ⅲ study[J]. Ann Oncol, 2016, 27(5): 834-842. doi: 10.1093/annonc/mdw062

    [17]

    Scheer AS, Boushey RP, Liang S, et al. The long-term gastrointestinal functional outcomes following curative anterior resection in adults with rectal cancer: a systematic review and meta-analysis[J]. Dis Colon Rectum, 2011, 54(12): 1589-1597. doi: 10.1097/DCR.0b013e3182214f11

    [18] 蒲羽, 邱远, 李祥, 等. 直肠癌保肛术后低位前切除综合征发生率、恢复情况及影响因素的回顾性分析[J]. 第三军医大学学报, 2017, 39(10): 1025-1030. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201710017.htm

    Pu Y, Qiu Y, Li X, et al. Incidence, risk factor and recovery of low anterior resection syndrome following sphincter-preserving surgery for rectal cancer: a retrospective analysis of 337 cases[J]. Di San Jun Yi Da Xue Xue Bao, 2017, 39(10): 1025-1030. https://www.cnki.com.cn/Article/CJFDTOTAL-DSDX201710017.htm

    [19]

    Ekkarat P, Boonpipattanapong T, Tantiphlachiva K, et al. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients[J]. Asian J Surg, 2016, 39(4): 225-231. doi: 10.1016/j.asjsur.2015.07.003

表(5)
计量
  • 文章访问数:  2629
  • HTML全文浏览量:  609
  • PDF下载量:  799
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-04-13
  • 修回日期:  2021-08-10
  • 网络出版日期:  2024-01-12
  • 刊出日期:  2021-12-24

目录

    /

    返回文章
    返回
    x 关闭 永久关闭