多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究_《中國普外基礎與臨床雜志》

作者：

汪曉東 , 曹霖 , 呂東昊 , 邱萌 , 李立

1.四川大學華西醫院肛腸外科(成都610041);;
2.四川大學華西醫院腫瘤科(成都610041);

關鍵詞：

新輔助化療風險評估多學科協作結直腸癌

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目的　應用英國結直腸醫師協會結直腸癌術后風險評估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)對結直腸癌新輔助化療聯合手術綜合治療策略進行風險評估。
方法　回顧性研究了2007年7~11月期間在四川大學華西醫院肛腸外科專業組收治確診為結直腸癌的患者181例，男102例，女79例; 平均年齡58.78歲; 結腸癌62例，直腸癌119例。根據是否納入多學科協作(MDT)診治模式分為MDT組(n=65)和非MDT組(n＝116)，采用ACPGBI-CCM評估所有納入患者的手術風險。
結果　MDT組與非MDT組之間基線一致。以中位預測死亡率(2.07%)為界分為低風險組(lower risk group,LRG,n=92)和高風險組(higher risk group,HRG,n=89)。無論在LRG或HRG中，MDT組患者胃管、尿管和引流管拔除的時間，經口進食和術后下床活動時間均比非MDT組更早(P＜0.05)。LRG腫瘤切除率明顯高于HRG(P＜0.05); Dukes分期構成比的差異有統計學意義(P＜0.05); HRG預測死亡率值明顯大于LRG(P＜0.05)，而實際死亡例數在HRG和LRG內均為0。
結論　LRG的預測死亡率低于HRG與Dukes分期被納入ACPGBI-CCM評估必備指標有密切關系，ACPGBI-CCM是否可以評價術后30 d內并發癥的發生率還有待進一步驗證。選擇應用新輔助化療聯合手術的綜合治療策略并沒有顯著增加患者術后預測死亡率的風險。通過術后的風險評估，全面分析MDT診治模式下綜合治療聯合流程改造的臨床近期安全性，將為術后風險評估增加新的內涵。

引用本文： 汪曉東,曹霖,呂東昊,邱萌,李立. 多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究. 中國普外基礎與臨床雜志, 2008, 15(9): 692-696. doi: 復制

1.	汪曉東, 曾天芳, 曹霖, 等. 多學科協作診治模式下新輔助化療干預結直腸癌手術方案的臨床研究 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6)∶451.
2.	Glynne-Jones R, Harrison M. Locally advanced rectal cancer: what is the evidence for induction chemoradiation? [Ｊ]. Oncologyist, 2007; 12(11)∶1309.
3.	Al-Homoud S, Purkayastha S, Aziz O, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models [Ｊ]. Surg Oncol, 2004; 13(2-3)∶83.
4.	Bromage SJ, Cunliffe WJ. Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center [Ｊ]. Dis Colon Rectum, 2007; 50(2)∶192.
5.	呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶713.
6.	Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [Ｊ]. ANZ J Surg, 2002; 72(6)∶421.
7.	汪曉東, 馮碩, 游小林, 等. 結直腸腫瘤多學科協作診治模式下的隨訪體系建設 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶709.
8.	Tekkis PP, Poloniecki JD, Thompson MR, et al. Operative mortality in colorectal cancer: prospective national study[Ｊ]. BMJ, 2003; 327(7425)∶1196.
9.	Chao MW, Tjandra JJ, Gibbs P, et al. How safe is adjuvant chemotherapy and radiotherapy for rectal cancer? [Ｊ]. Asian J Surg, 2004; 27(2)∶147.
10.	Glynne-Jones R, Sebag-Montefiore D. Role of neoadjuvant che-motherapy in rectal cancer: interpretation of the EXPERT study [Ｊ]. J Clin Oncol, 2006; 24(28)∶4664.
11.	Buie WD, MacLean AR, Attard JA, et al. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(10)∶1868.
12.	Wichmann MW, Meyer G, Adam M, et al. Detrimental immunologic effects of preoperative chemoradiotherapy in advanced rectal cancer [Ｊ]. Dis Colon Rectum, 2003; 46(7)∶875.
13.	Metcalfe, Nrwood MG, Miller AS, et al. Unreasonable expections in emergency colorectal cancer surgery [Ｊ]. Colorect Dis, 2005; 7(3)∶275.
14.	Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.

1. 　汪曉東, 曾天芳, 曹霖, 等. 多學科協作診治模式下新輔助化療干預結直腸癌手術方案的臨床研究 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(6)∶451.
2. 　Glynne-Jones R, Harrison M. Locally advanced rectal cancer: what is the evidence for induction chemoradiation? [Ｊ]. Oncologyist, 2007; 12(11)∶1309.
3. 　Al-Homoud S, Purkayastha S, Aziz O, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models [Ｊ]. Surg Oncol, 2004; 13(2-3)∶83.
4. 　Bromage SJ, Cunliffe WJ. Validation of the CR-POSSUM risk-adjusted scoring system for major colorectal cancer surgery in a single center [Ｊ]. Dis Colon Rectum, 2007; 50(2)∶192.
5. 　呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶713.
6. 　Isbister WH, Al-Sanea N. POSSUM: a re-evaluation in patients undergoing surgery for rectal cancer. The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [Ｊ]. ANZ J Surg, 2002; 72(6)∶421.
7. 　汪曉東, 馮碩, 游小林, 等. 結直腸腫瘤多學科協作診治模式下的隨訪體系建設 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶709.
8. 　Tekkis PP, Poloniecki JD, Thompson MR, et al. Operative mortality in colorectal cancer: prospective national study[Ｊ]. BMJ, 2003; 327(7425)∶1196.
9. 　Chao MW, Tjandra JJ, Gibbs P, et al. How safe is adjuvant chemotherapy and radiotherapy for rectal cancer? [Ｊ]. Asian J Surg, 2004; 27(2)∶147.
10. 　Glynne-Jones R, Sebag-Montefiore D. Role of neoadjuvant che-motherapy in rectal cancer: interpretation of the EXPERT study [Ｊ]. J Clin Oncol, 2006; 24(28)∶4664.
11. 　Buie WD, MacLean AR, Attard JA, et al. Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(10)∶1868.
12. 　Wichmann MW, Meyer G, Adam M, et al. Detrimental immunologic effects of preoperative chemoradiotherapy in advanced rectal cancer [Ｊ]. Dis Colon Rectum, 2003; 46(7)∶875.
13. 　Metcalfe, Nrwood MG, Miller AS, et al. Unreasonable expections in emergency colorectal cancer surgery [Ｊ]. Colorect Dis, 2005; 7(3)∶275.
14. 　Ferjani AM, Griffin D, Stallard N, et al. A newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.

《中國普外基礎與臨床雜志》

多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究

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《中國普外基礎與臨床雜志》

多學科協作診治模式下結直腸癌新輔助化療聯合手術的風險評估研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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