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博碩士論文 etd-0420113-152709 詳細資訊
Title page for etd-0420113-152709
論文名稱
Title
直腸癌患者接受手術前化學放射治療後腫瘤衰退程度的臨床預後意義
Clinical Significance of Tumor Regression Grading after Preoperative Chemoradiotherapy for Rectal Cancer
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
46
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2013-05-02
繳交日期
Date of Submission
2013-05-20
關鍵字
Keywords
存活率、腫瘤衰退程度、手術前、化學放射治療、直腸癌
preoperative, rectal cancer, chemoradiotherapy, survival, tumor regression grading
統計
Statistics
本論文已被瀏覽 5733 次,被下載 707
The thesis/dissertation has been browsed 5733 times, has been downloaded 707 times.
中文摘要
對於局部晚期的直腸癌病患,使用手術前化學放射線治療再行開刀是現在的標準作法,但目前沒有一個被建議的檢驗去預測這些病患的預後。因此本研究利用手術後病理下的腫瘤衰退程度來與臨床病理預後因子和存活率來作分析。回朔性分析從1998年1月至2008年12月,共172位直腸癌病患,使用手術前的化學放射治療,包含45-50.4葛雷的骨盆範圍放射線照射合併同步化學治療(5-FU, 300 毫克/平方公尺/天,連續注射24小時,每週五天,約五週半),之後病人休息4到6週後再行開刀。最後根據開刀後病理切片下不同腫瘤衰退程度來做分析比較。在我們的研究顯示,這172位患者的病理切片下,腫瘤完全衰退者(TRG 4)佔9.9%,腫瘤中等衰退者(TRG 2-3)佔68.6%,而腫瘤少量甚至無衰退者(TRG 0-1)佔21.5% 。五年存活率在腫瘤完全衰退者(TRG 4)為93%,腫瘤中等衰退者(TRG 2-3)為77%,而腫瘤少量甚至無衰退者(TRG 0-1)僅為47%,達顯著意義 (P=.037)。另外在單變項分析中,腫瘤衰退程度越高者,也同樣有較佳的五年局部控制、疾病控制與遠端轉移控制率;但是在多變項分析下腫瘤衰退程度僅與五年局部控制與疾病控制率有關,而與遠端轉移控制率無關,同時臨床病理因子也僅剩血管侵犯為相關的獨立預後因子。所以根據我們的研究結果,接受手術前化學放射治療的直腸癌病患,其腫瘤衰退程度越高者,局部控制與存活率均較優,同時,腫瘤衰退程度為一個重要的預後因子,但對遠端轉移卻無法預測。
Abstract
Preoperative chemoradiotherapy has been the standard treatment for locally advanced rectal cancer patients but there is no technique suggested to be used to predicate the outcome. Here, we use the tumor regression grading (TRG) and analyzed it with clinic-pathological parameters and survival rate. One hundred and seventy-two patients with rectal cancers were enrolled in this study from January 1998 to December 2008. All patients underwent preoperative chemoradiotherapy and curative surgery for rectal cancer (stages I-III) at our institute. TRG was retrospective reviwed on excised specimens from the patients after radical surgery. Preoperative concurrent chemoradiotherapy was given at a total dose of 45-50.4 Gy in 25 fractions over a period about 5.5 weeks, and a continuous infusion of 5-fluorouracil (300 mg/m2/day over 24 hours, 5 days per week for 5 weeks) was administered. Surgery was performed 4-6 weeks after completion of the preoperative chemoradiotherapy. Our result showed that subgroup of complete response (TRG 4), intermittent response (TRG 2-3), and minor or no response TRG (0-1) were found in 9.9%, 68.6%, and 21.5% of these resected specimens. Five-year overall survival (OS) after preoperative chemoradiotherapy and curative resection was 93% for TRG 4, 77% for grouped TRG 2-3, and 47% for grouped TRG 0-1 (P=.037). Patients with more tumor regression (4 vs. 2-3 vs. 01) also have better results for 5-year local-free (LFS), disease-free (DFS), and metastases free survival (MFS) (P = .004, P = .002, and P = .0001, respectively). But in multivariate analysis, the vascular invasion of pathologic specimens and TRG were the most important independent prognostic factors for LFS and DFS. In conclusion, higher TRG after preoperative chemoradiotherapy for rectal cancer closely contributed to better survival and local control. The TRG is considered to be a significant prognostic factor but it could not predict distant metastases.
目次 Table of Contents
Introduction+1
Materials and Methods+5
Eligibility+5
Treatment plan+6
Preoperative chemoradiotherapy+6
Surgery+6
Histopathological examination+7
Follow up+8
Statistical analysis+9
Results+10
Patient characteristics+10
Clinical and Pathologic Findings+10
Survival Analysis with TRG and clicopathological parameters+11
Discussion+13
Prediction of response to preoperative treatment+13
Carcinoembriogenic antigen (CEA) and molecular marker prediction+14
Clinical and pathologic down-staging+14
Tumor regression grade+15
Prognostic role of TRG+15
Limitation+19
Conclusion+20
Future directions+21
Tables+22
Figures+25
References+33
Appendix+37
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