目的 應用英國結(jié)直腸醫(yī)師協(xié)會結(jié)直腸癌術(shù)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(jié)直腸癌新輔助化療聯(lián)合手術(shù)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(yī)院肛腸外科專業(yè)組收治確診為結(jié)直腸癌的患者181例，男102例，女79例; 平均年齡58.78歲; 結(jié)腸癌62例，直腸癌119例。根據(jù)是否納入多學科協(xié)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(shù)風險。
結(jié)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(jīng)口進食和術(shù)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(gòu)成比的差異有統(tǒng)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(shù)在HRG和LRG內(nèi)均為0。
結(jié)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(guān)系，ACPGBI-CCM是否可以評價術(shù)后30 d內(nèi)并發(fā)癥的發(fā)生率還有待進一步驗證。選擇應用新輔助化療聯(lián)合手術(shù)的綜合治療策略并沒有顯著增加患者術(shù)后預測死亡率的風險。通過術(shù)后的風險評估，全面分析MDT診治模式下綜合治療聯(lián)合流程改造的臨床近期安全性，將為術(shù)后風險評估增加新的內(nèi)涵。
引用本文： 汪曉東,曹霖,呂東昊,邱萌,李立. 多學科協(xié)作診治模式下結(jié)直腸癌新輔助化療聯(lián)合手術(shù)的風險評估研究. 中國普外基礎(chǔ)與臨床雜志, 2008, 15(9): 692-696. doi: 復制
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- 1. 汪曉東, 曾天芳, 曹霖, 等. 多學科協(xié)作診治模式下新輔助化療干預結(jié)直腸癌手術(shù)方案的臨床研究 [Ｊ]. 中國普外基礎(chǔ)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(jié)直腸腫瘤多學科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [Ｊ]. 中國普外基礎(chǔ)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(jié)直腸腫瘤多學科協(xié)作診治模式下的隨訪體系建設(shè) [Ｊ]. 中國普外基礎(chǔ)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.