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目的:探讨局部晚期直肠癌新辅助放化疗结束与手术的间隔时间对病理及临床疗效的影响。方法:回顾性分析2010年1月至2013年7月间接受新辅助放化疗随后行根治性手术的78例初治局部晚期直肠癌患者的临床资料。根据新辅助治疗结束至手术的间隔时间中位数分为两组,A组为新辅助放化疗结束后﹤7周手术治疗38例;B组为≥7周手术治疗40例。全部患者采用三维适形调强放疗,2Gy/1次,5次/1周,总50Gy,同步行氟尿嘧啶为基础的化疗,比较两组患者肿瘤病理退缩分级(TGR)、降期率、手术并发症发生率、局部复发率、远处转移率和生存率。结果:TRG1、TRG2、TRG3、TRG4(PCR)A组分别为9例、7例、10例、6例,B组分别为9例、9例、12例、8例(P=0.614);T分期降期率A组63.2%,B组52.5%(P=0.368),N分期降期率A组39.5%,B组55%(P=0.039);手术并发症发生率A组18.4%,B组20%(P=0.550);3年复发率A组7.9%,B组10%(P=0.745);远处转移率A组13.2%,B组10%(P=0.663);3年生存率A组70.8%,B组84%(P=0.453)。结论:新辅助放化疗结束≥7周行手术,可以获得较高的淋巴结降期率,不增加手术难度和并发症发生率。
Objective: To investigate the effect of the interval between neoadjuvant chemoradiotherapy and surgery on the pathology and clinical efficacy in locally advanced rectal cancer. Methods: The clinical data of 78 patients with locally advanced locally advanced rectal cancer undergoing neoadjuvant chemoradiation followed by radical surgery from January 2010 to July 2013 were retrospectively analyzed. According to the neoadjuvant treatment to the median interval between surgery is divided into two groups, A group of neoadjuvant radiotherapy and chemotherapy after the end of <7 weeks surgical treatment of 38 cases; B group of ≥ 7 weeks of surgical treatment of 40 cases. All patients underwent three-dimensional conformal intensity-modulated radiation therapy, 2Gy / 1 times, 5 times / 1 week, total 50Gy, concurrent fluorouracil-based chemotherapy, comparing the two groups of patients with tumor pathological regression grade (TGR) Disease incidence, local recurrence rate, distant metastasis rate and survival rate. Results: The number of TRG1, TRG2, TRG3 and TRG4 (PCR) group A was 9, 7, 10 and 6, respectively, in group B were 9, 9, 12 and 8 The staging down rate was 63.2% in group A, 52.5% in group B (P = 0.368), 39.5% in stage N in group A, and 55% in group B (P = 0.039). The incidence of complications in group A was 18.4% (P = 0.550). The 3-year relapse rate was 7.9% in group A and 10% in group B (P = 0.745). The distant metastasis rate was 13.2% in group A and 10% in group B (P = 0.663) Rate of 70.8% in group A, 84% in group B (P = 0.453). Conclusion: Neo-adjuvant radiotherapy and chemotherapy for more than 7 weeks after the end of surgery, you can get a higher rate of lymph node metastasis, without increasing the difficulty of surgery and complications.