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目的探讨低位局部进展期直肠癌新辅助放化疗后完全缓解病例的进一步治疗方案及效果。方法回顾性分析江苏省中医院肿瘤外科2008年1月至2010年5月期间行新辅助放化疗后初步判断达到病理完全缓解(pCR)的14例低位局部进展期直肠癌患者的临床资料。结果 14例患者中接受手术者10例,术后真正达到pCR者5例;术后2例复发或转移,其中死亡1例,1例带瘤生存,余8例患者均无瘤生存。未行手术的4例患者中,有3例复发或转移,其中2例死亡,1例带瘤生存;余1例无瘤生存。4例未行手术病例中CEA水平正常者(<5μg/L)2例(1例复发或转移),CEA升高的2例均发生转移;10例手术病例中CEA水平正常者6例(均无瘤生存,4例真正达到pCR),升高者4例(1例真正达到pCR,2例复发或转移)。结论接受新辅助放化疗后初步判断达到pCR的病例,尤其是CEA值高于正常者,应接受规范的全直肠系膜切除(TME)手术以达到根治的目的。
Objective To investigate the further treatment of complete remission after neoadjuvant chemoradiotherapy in patients with locally advanced low rectal cancer. Methods The clinical data of 14 patients with locally advanced rectal cancer who underwent neoadjuvant radiochemotherapy and were initially judged to have pathologic complete remission (pCR) between January 2008 and May 2010 were retrospectively analyzed. Results Of the 14 patients, 10 received surgery and 5 achieved true postoperative pCR. Two patients relapsed or metastasized after operation, of which 1 died and 1 survived. More than 8 patients survived without tumor. Of the 4 patients who did not undergo surgery, 3 had recurrence or metastasis, of which 2 died and 1 survived with tumor; the other 1 patient survived without tumor. 2 cases (1 case of relapse or metastasis) had CEA level normal (<5μg / L) in 4 cases without operation, and 2 cases with elevated CEA were in all cases; 6 cases with normal CEA level in 10 cases No tumor-free survival, 4 cases achieved true pCR), 4 cases of elevated (1 case of true pCR, 2 cases of recurrence or metastasis). Conclusions The cases of newly diagnosed patients with pCR after neoadjuvant chemoradiotherapy, especially those with CEA higher than normal, should undergo standard total mesorectal excision (TME) surgery to achieve radical curative effect.