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目的分析局部进展期低位直肠癌术前放化疗加前切除术或术前放疗加前切除术与Miles手术的远期效果。方法157例低位直肠癌患者为1983年1月至2000年12月收治,原发肿瘤距肛门中位距离6.1cm,临床分期Ⅱ期69例,Ⅲ期88例(TNM,UICC)。放疗方法为术前直线加速器的盆腔四野照射,35～45Gy/4～5周;化疗方法为以氟尿嘧啶为主的联合化疗。予以术前放、化疗加前切除术52例(A组);术前单纯放疗加前切除术51例(B组);单纯Miles手术54例(C组)。对全部患者的临床资料和随访结果进行回顾性分析。结果本组随访率91.7%。5年生存率A组71.1%,B组47.1%,C组42.6%;A组明显高于B和C组(P<0.05)。无瘤生存率A组61.5%,B组37.3%,C组35.2%;A组仍明显高于B和C组(P<0.05)。局部复发率A组13.5%,B组15.7%,C组11.1%;3组之间差异无统计学意义(P>0.05)。远处转移率(包括局部复发加远处转移)A组23.1%,B组49.0%,C组46.3%;A组明显低于B和C组(P<0.05)。但B组与C组的差异无统计学意义(P>0.05)。结论术前放、化疗加前切除手术治疗低位直肠癌的方法可改善5年生存率和无瘤生存率,降低远处转移率。
Objective To analyze the long-term effect of preoperative radiotherapy and chemotherapy combined with preoperative radiotherapy and anterior resection and Miles operation in locally advanced low rectal cancer. Methods A total of 157 patients with low rectal cancer were admitted to our hospital from January 1983 to December 2000. The primary tumor was located at a distance of 6.1cm from the anus. There were 69 cases in stage Ⅱ and 88 cases in stage Ⅲ (TNM, UICC). Radiotherapy method for the preoperative linear accelerator pelvic four field irradiation, 35 ~ 45Gy / 4 ~ 5 weeks; chemotherapy with fluorouracil-based combination chemotherapy. Preoperative radiotherapy and chemotherapy plus anterior resection in 52 cases (group A); preoperative radiotherapy and anterior resection in 51 cases (group B); simple Miles operation in 54 cases (group C). The clinical data and follow-up results of all patients were retrospectively analyzed. Results The follow-up rate was 91.7% in this group. The 5-year survival rate was 71.1% in group A, 47.1% in group B and 42.6% in group C, and significantly higher in group A than in groups B and C (P <0.05). The tumor-free survival rate was 61.5% in group A, 37.3% in group B, and 35.2% in group C, while it was still significantly higher in group A than those in groups B and C (P <0.05). The local recurrence rate in group A was 13.5%, in group B 15.7% and in group C 11.1%. There was no significant difference between the three groups (P> 0.05). The distant metastasis rate (including local recurrence plus distant metastasis) was 23.1% in group A, 49.0% in group B, and 46.3% in group C, and significantly lower in group A than in groups B and C (P <0.05). However, there was no significant difference between group B and group C (P> 0.05). Conclusion Preoperative radiotherapy and chemotherapy combined with anterior resection of lower rectal cancer can improve the 5-year survival rate and tumor-free survival rate, reduce the distant metastasis rate.