| 摘要: |
| ［摘要］ 目的 分析无重大基础疾病的局部进展期直肠癌（LARC）患者接受新辅助放化疗（nCRT）联合全直肠系膜切除术（TME）后的预后影响因素。方法 回顾性分析中国医学科学院北京协和医学院肿瘤医院2013年1月至2023年5月收治的接受nCRT联合TME治疗的无重大基础疾病的316例LARC患者的临床资料。术后通过门诊复查、电话随访及肿瘤登记系统随访相结合的方式随访至2026年3月1日。收集患者的临床资料。采用Kaplan-Meier法绘制生存曲线，以log-rank检验进行组间比较。采用Cox回归分析各临床变量与总生存期（OS）、无病生存期（DFS）的关联。结果 中位随访时间为70个月（范围：12～120个月），随访期间无失访病例，105例（33.23%）因直肠癌复发或转移死亡，211例（66.77%）存活。Kaplan-Meier生存曲线分析显示，脉管癌栓、肿瘤分化程度、ypN分期及壁外血管侵犯（EMVI）与OS和DFS显著相关（P<0.05）。多因素Cox回归分析显示，EMVI阳性、肿瘤低分化、脉管癌栓阳性及ypN分期为N+是影响OS和DFS的独立危险因素（P<0.05）。结论 EMVI、肿瘤分化程度、脉管癌栓及ypN分期是无重大基础疾病LARC患者nCRT联合TME后的独立预后影响因素。 |
| 关键词: 局部进展期直肠癌 新辅助放化疗 预后 影响因素 基础疾病 |
| DOI：10.3969/j.issn.1674-3806.2026.08.09 |
| 分类号:R 735.37 |
| 基金项目:北京市自然科学基金-海淀原始创新联合基金资助项目（编号：L222054）；中央高水平医院临床科研业务费及中国医学科学院肿瘤医院合作基金（北京-廊坊-深圳）（编号：CFA202502023） |
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| Analysis of prognostic factors in strictly selected locally advanced rectal cancer patients without major underlying diseases after neoadjuvant chemoradiotherapy combined with total mesorectal excision |
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Du Jinbo1, Zhang Manyu2, Niu Huiyong2, Xing Zhaodong1, Wang Yuhan1, Hu Gang1, Li Bo1, Tang Jianqiang1
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1.Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; 2.School of Clinical Medicine, Hebei University, Baoding 071000, China
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| Abstract: |
| ［Abstract］ Objective To analyze prognostic factors in locally advanced rectal cancer(LARC) patients without major underlying diseases after receiving neoadjuvant chemoradiotherapy(nCRT) combined with total mesorectal excision(TME). Methods A retrospective analysis was conducted on the clinical data of 316 LARC patients without major underlying diseases who received nCRT combined with TME treatment in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2013 to May 2023. After the operation, the follow-up was conducted through a combination of outpatient reexaminations, phone calls and the tumor registration system until March 1, 2026. The clinical data of the patients were collected. Survival curves were plotted using Kaplan-Meier method, and comparisons between groups were conducted using log-rank test. Cox regression was used to analyze the associations of clinical variables with overall survival(OS) and disease-free survival(DFS). Results The median follow-up time was 70 months(ranging from 12 to 120 months). During the follow-up period, no patients were lost to follow-up; 105 patients(33.23%) died due to recurrent rectal cancer or metastasis, and 211 patients(66.77%) survived. Kaplan-Meier survival curve analysis showed that vascular tumor thrombus, degree of tumor differentiation, lymph node(ypN) stage and extramural vascular invasion(EMVI) were significantly correlated with OS and DFS(P<0.05). Multivariate Cox regression analysis showed that EMVI positivity, poor tumor differentiation, positive for vascular tumor thrombus, and ypN+ stage were independent risk factors affecting OS and DFS(P<0.05). Conclusion EMVI, degree of tumor differentiation, vascular tumor thrombus, and ypN stage are independent prognostic factors for LARC patients without major underlying disease after nCRT combined with TME. |
| Key words: locally advanced rectal cancer(LARC) neoadjuvant chemoradiotherapy(nCRT) prognosis influencing factors underlying diseases |
