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目的:探讨用原发灶大体肿瘤体积(GTV)预测局部进展期直肠癌(LARC)患者行新辅助放化疗(nCRT)后病理完全缓解(pCR)可行性。方法:回顾中南大学湘雅医院胃肠外科2009年3月—2015年12月行nCRT后予以根治性切除的LRAC患者107例资料,分析LARC患者行nCRT后到达pCR的临床预测因素,免疫组化检测患者肿瘤组织中直肠癌干细胞标志物CD133的表达,并分析原发灶GTV与直肠癌干细胞的关系。结果:107例LARC患者中,25例(23.36%)获pCR。LARC患者的原发灶GTV与肿瘤原发灶沿肠纵轴长度(r=0.580,P<0.001)及肿瘤原发灶最大径(r=0.608,P<0.001)均成正相关,但pCR患者与非pCR患者间仅在原发灶GTV(P=0.024)、nCRT前血清CEA水平(P=0.020)及多药化疗方案(P=0.05)方面存在明显差异。ROC曲线确定原发灶GTV判断肿瘤反应的最佳截点值为70.29 cm~3。Logistic回归分析显示,小原发灶GTV(<70 cm~3)(P=0.019)与多药联合化疗(P=0.032)LRAC患者nCRT后pCR的独立促进因素;大原发灶GTV(≥70 cm~3)的患者肿瘤组织CD133表达量明显高于小原发灶GTV(<70 cm~3)的患者(P=0.017)。结论:原发灶GTV可作为LARC患者行nCRT后pCR的独立预测因素,原发灶GTV大者pCR率低,原因可能部分与原发灶GTV越大肿瘤中的肿瘤干细胞量越高有关。
Objective: To investigate the feasibility of neoplasm-based chemoradiotherapy (nCRT) for complete remission (pCR) in patients with locally advanced rectal cancer (LARC) using gross tumor volume (GTV) of primary tumor. Methods: The data of 107 LRAC patients who undergone radical resection after nCRT from March 2009 to December 2015 in Xiangya Hospital of Central South University were retrospectively analyzed. The clinical prognostic factors of patients with LARC after reaching nCRT were analyzed. Immunohistochemistry The expression of CD133, a marker of rectal cancer stem cells, was detected in the tumor tissues of patients and the relationship between GTV and rectal cancer stem cells was analyzed. Results: Of the 107 LARC patients, 25 (23.36%) had pCR. The GTV of primary tumor in LARC patients was positively correlated with the length of longitudinal axis (r = 0.580, P <0.001) and the maximum tumor diameter (r = 0.608, P <0.001) There was a significant difference between non-pCR patients in terms of GTV of primary tumor (P = 0.024), serum CEA level before nCRT (P = 0.020) and multi-drug chemotherapy regimen (P = 0.05) The best cut-off point of the tumor response of GTV in the primary tumor was 70.29 cm ~ 3 by ROC curve. Logistic regression analysis showed that there was a significant difference between the two groups (P <0.05). The incidence of GCR (> 70 cm ~ 3) (P = 0.019) cm ~ 3) was significantly higher than that of the small primary GTV (<70 cm ~ 3) (P = 0.017). CONCLUSIONS: GTV can be used as an independent predictor of pCR in patients with LARC after nCRT. The high prevalence of GCR in patients with primary GCR has a low pCR rate, which may be related to the higher GTV in the primary tumor.