新辅助化疗在可切除结肠癌肝转移中的研究

发布时间：2019-03-20 19:49

【摘要】：目的:比较分析新辅助化疗联合手术对比单独手术对可切除结肠癌肝转移患者生存的影响,评价新辅助化疗在可切除结肠癌肝转移患者中的价值。方法:回顾性分析2010年1月到2015年12月在中国医学科学院肿瘤医院行手术治疗的符合入组条件的85例结肠癌肝转移患者,按照术前是否行新辅助化疗分为两组:新辅助化疗联合手术组(n=37)和单纯手术组(n=48),对比分析两组的临床特征,两组患者的临床病理特征无显著性差异,具有可比性。并用Kaplan-Meier法绘制生存曲线,用Log-rank检验比较两组患者生存率的差异,COX回归分析影响生存的因素,以P0.05界定为有显著性差异。结果:新辅助化疗联合手术组的患者中位总生存时间(overall survival,OS)为36个月,中位疾病无进展生存时间(disease-free survival,DFS)为19个月,3年和1年生存率分别为33%和80%。单纯手术组的患者中位OS为31个月,中位DFS为16个月,3年和1年的生存率分别为25%和67%。新辅助化疗联合手术组疾病进展的发生率为62.2%,单纯手术组的疾病进展的发生率为72.9%,两组患者术后不良反应、OS和DPS上无显著性差异(p=0.388和p=0.225),但是在对亚组的分析中发现,原发肿瘤位于右半结肠、≥4个肝转移灶、最大肝转移灶直径5cm、血清CEA(carcino-embryonic antigen,癌胚抗原)≥5ng/ml、肿瘤切缘阳性是影响预后的因素,COX多因素分析进一步验证血清CEA≥5ng/ml、肝转移灶5cm、肿瘤切缘阳性为本研究中影响患者预后的独立危险因素。结论:同单纯手术相比,新辅助化疗并没有增加死亡率及术后相关并发症,但同时也没有OS和DFS上的优势,亚组的分析中发现,血清CEA≥5ng/ml、肝转移灶5cm、肿瘤切缘阳性是结肠癌肝转移的独立危险因素。
[Abstract]:Aim: to compare the effects of neoadjuvant chemotherapy combined with surgery on survival of patients with liver metastasis of resectable colon cancer and evaluate the value of neoadjuvant chemotherapy in patients with liver metastasis of resectable colon cancer. Methods: from January 2010 to December 2015, 85 patients with liver metastasis of colon cancer who were treated by operation in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. According to whether or not neoadjuvant chemotherapy was performed before operation, two groups were divided into two groups: neoadjuvant chemotherapy combined with operation group (n = 37) and simple operation group (n = 48). The clinical features of the two groups were compared and analyzed. There was no significant difference in clinical and pathological features between the two groups, and the clinical and pathological features of the two groups were comparable. Kaplan-Meier method was used to draw survival curve, Log-rank test was used to compare the difference of survival rate between the two groups. COX regression analysis showed that there was significant difference between the two groups (P0.05). Results: the median total survival time (overall survival,OS) was 36 months, the median progression-free survival time (disease-free survival,DFS) was 19 months, and the 3-year and 1-year survival rates were 33% and 80%, respectively. The median OS was 31 months and the median DFS was 16 months in the simple operation group. The 3-year and 1-year survival rates were 25% and 67%, respectively. The incidence of disease progression was 62.2% in neoadjuvant chemotherapy combined with surgery group and 72.9% in simple operation group. There was no significant difference in OS and DPS between the two groups in postoperative adverse reactions (p < 0. 388 and p < 0. 225), but there was no significant difference between the two groups (p < 0. 388 and p = 0. 225). But in the subgroup analysis, it was found that the primary tumor was located in the right hemicolon, 鈮，

本文编号：2444574