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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。
BACKGROUND & OBJECTIVE: Neoadjuvant therapy (radiotherapy or chemoradiation) can change the depth of invasion and lymph node metastasis of rectal cancer. However, lymph node metastasis is important for the selection of new adjuvant therapy and subsequent treatment options for rectal cancer Reference effect. The purpose of this study was to retrospectively analyze the related factors affecting lymph node metastasis after neoadjuvant treatment of rectal cancer. Methods: Ninety-three cases of low and middle rectal cancer receiving neoadjuvant therapy and TME surgery from August 2003 to February 2008 were collected and a database was established. The age, sex, distance from tumor to anus, tissue type, T stage (ypT stage) after neoadjuvant therapy, serum CEA level and CA19-9 level before radiotherapy, serum CEA level after radiotherapy and CA19-9 levels, radiation dose, with or without chemotherapy containing oxaliplatin chemotherapy, radiotherapy and surgery time interval of 12 clinical and pathological parameters and treatment parameters, using univariate and multivariate analysis of the study Factors Affecting Lymph Node Metastasis in 93 Cases of Neoadjuvant Rectal Cancer Patients. Results: Univariate analysis showed that serum CEA level, radiation dose, time interval between radiotherapy and surgery, concurrent chemotherapy with oxaliplatin-containing regimen, and ypT staging were lymph node metastases (ypN staging) after neoadjuvant therapy relevant factor. Logistic regression model multivariate analysis showed that the response to oxaliplatin-containing chemotherapy and postoperative T-stage were independent factors of lymph node metastasis, the correlation coefficients were -0.481 and 0.503, respectively. Conclusion: The ypT staging is still related to the ypN staging after neoadjuvant treatment of rectal cancer, and the lymph node metastasis rate of ypT0-1 patients is low. Concurrent chemotherapy with oxaliplatin can significantly reduce the risk of lymph node metastases and has the potential to improve prognosis.