| Objective: To explore the short-and-long-term efficacy of locally advanced mid rectal cancer(LARC) patients who underwent neoadjuvant hemoradiotherapy(CRT),analyse the related factors that effect their prognosis,and provide a reference for therapy choice in mid LARC.Methods:Based on the rectal segment method of 7th 《General rules for Clinical and Pathological Studies on Cancer of the Colon,Rectum and Anus 》, retrospective analysis of 201 patients with stage II-III mid rectal cancer who were treated in the Department of Colorectal Surgery in Fujian Medical University Union Hospital from April 2009 to December 2012,which were divided into neoadjuvant chemoradiotherapy group(CRT group) and surgery alone group(non-CRT group),anlyse the tumor response of CRT group and compare the prognosis of the two groups.Results:1.After CRT,14.5%(11/76) of the patients in CRT group showed pathologically complete regression(p CR),they showed good outcomes in tumor size,T staging and N staging:(1)tumor size:In CRT group,85.5%(65/76) of the patients’ maximum diameter of tumor was shorter after chemoradiation therapy, 47.4%(36/76)got patial recover(PR), 50.0%(38/76)got stable disease(SD),2.6(2/76) got progresive disease(PD);c T staging:In CRT group,50.0%(38/76) of the patients demonstrated a tumor down-staging after chemoradiation therapy, 44.7%(36/76) stay the same,5.3%(4/76) showed progress.(3)c N staging:In CRT roup,53.7%(36/67) of the patients with N+ status demonstrated a tumor down-staging(N0),46.3%(31/67)showed no change;2.The CRT and non-CRT groups revealed no significant differences in the 3-year disease-free survival rate,the local recurrence rate and distant metastasis rate for all the mid LARC patients(78.9% vs 75.8%,P =0.699;3.9% vs 7.0%,P =0.365;17.1% vs 20.3%,P =0.573).For the c T3 patients,The CRT and non-CRT groups revealed no significant differences in the 3-year disease-freesurvival rate,the local recurrence rate and distant metastasis rate(81.1% vs 83.5%,P=0.687;3.8% vs4.1%P =0.917;15.1%vs 14.4%,P =0.913).For the c T4 patients,The CRT and non-CRT groups revealed significant differences in the 3-year disease-free survival rate,the local recurrence rate and distant metastasis rate(73.9%vs32.1%,P=0.037; 4.3%vs 25.0%,P =0.044;21.7%vs50.0%,P =0.038). COX multivariate analysis indicated that tumor differentiation,(y)p T staging and(y)p N staging were independent prognostic factors for DFS(P <0.05).Conclusions:1.CRT can reduce the tumor size of partial mid LARC,and acquire down-staging,even p CR;2.CRT can improve the prognosis of patients with c T4 mid LARC, but may not significantly influence the prognosis of patients with c T3. |
