实用医学杂志 ›› 2022, Vol. 38 ›› Issue (21): 2691-2696.doi: 10.3969/j.issn.1006⁃5725.2022.21.011
中低位局部进展期直肠癌行新辅助放化疗后临床完全缓解患者采取等待观察策略的预后及影响因素分析
高树全1 武雪亮1，2 薛军1，2 屈明1 郭飞1 费建东1 张迎春1 马洪庆3
河北北方学院附属第一医院1 普通外科，2 肿瘤研究所（河北张家口 075000）；3 河北医科大学第四医院外二 科（石家庄 050000）
Prognosis and influencing factors analysis of watch ⁃and ⁃wait strategy in patients with complete clinical response after neoadjuvant chemoradiotherapy for middle⁃low locally advanced rectal cancer
GAO Shuquan*， WU Xueliang，XUE Jun，QU Ming，GUO Fei，FEI Jiandong，ZHANG Yingchun，MA Hongqing
Department of General Surgery，the First Affiliated Hospital of Hebei North University，Zhangjiakou 075000，China
摘要：
Objective To discuss prognosis and influencing factors of watch⁃and⁃wait（W&W）strategy in patients who had a clinical complete response after neoadjuvant chemoradiotherapy for rectal cancer. Methods The patients with clinical complete response after neo ⁃ adjuvant chemoradiotherapy for locally advanced rectal cancer who were enrolled in our hospital retrospectively between January 2015 and December 2019. The prognosis of patients with W&W strategy（46 cases）and total mesorectal excision（TME）（60 cases）were compared. The univariate and multivariate Cox proportional risk regression models were used to analyze the influencing factors of disease⁃free survival and overall survival in W&W patients. Results The median follow⁃up period was 36 months. The median disease⁃free survival，median overall survival，3⁃year disease⁃free survival，3⁃year overall survival and recurrence rates of W&W patients and TME patients were 32.6 months，35.7 months，80.43%，89.13%，19.57% and 35.1 months，38.4 months，83.33%，93.33%，16.67%，respectively，with no statistically significant differ⁃ ence（P > 0.05）. The univariate analysis showed that the disease⁃free survival was significantly shortened in W&W patients with tumor lower margin to anal margin distance ≤ 4 cm and positive lymph node metastasis（P < 0.05）， the overall survival was significantly shortened in W&W patients with positive lymph node metastasis（P < 0.05）. The multivariate analysis showed that the tumor lower margin to anal margin distance> ≤ 4 cm（HR = 16.371，95%CI：3.2369 ~ 134.542，P = 0.003）and positive lymph node metastasis（HR = 5.863，95%CI：1.127 ~ 12.334， P = 0.006）were found to be the independent risk factors for shortened disease ⁃free survival of W&W patients. The positive lymph node metastasis（HR = 4.602，95%CI：1.053 ~ 15.772，P = 0.038）was the independent risk factors for shortened overall survival of W&W patients. Conclusion After neoadjuvant chemoradiotherapy for rectal cancer，there was no significant difference in prognosis between patients who used the W&W strategy and those who used TME. The tumor lower margin to anal margin distance and lymph node metastasis status influenced the prognosis of W&W patients.
