局部进展期直肠癌新辅助放化疗敏感性预测因素的研究进展

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1、授予单位代码10089学号或申请号20153505中国图书分类号R735.3HebeiMedicalUniversity硕士学位论文专业学位局部进展期直肠癌新辅助放化疗敏感性预测因素的研究进展研究生：李晨辉导师：王贵英教授专业：外科学二级学院：第四医院2018年3月目录中文摘要························································································1英文摘要·························································

2、·······························2英文缩写························································································4综述局部进展期直肠癌新辅助放化疗敏感性预测因素的研究进展··5致谢·····························································································21个人简历································

3、······················································22中文摘要局部进展期直肠癌新辅助放化疗敏感性预测因素的研究进展摘要早期直肠癌（T1/2，或N0）通过单纯TME手术即可达到治愈，5年生存率高达90%以上。而对于局部进展期直肠癌(T3/4，或N+)，由于直接采用TME手术的局部复发率高、无法保留肛门，不能做到根治性切除(R0)等原因，国际及国内均首选术前的同步放化疗+TME手术+术后辅助治疗的综合治疗方案。术前同步放化疗对于局部进展期直肠癌有诸多优点，例如缩小肿瘤体积、降低局部肿瘤分期、增加R0切除可能性、降低放射

4、毒性、增加保肛率、降低局部复发率等。但是我们在临床中通常可以看到，不同个体对于标准的新辅助治疗的疗效却有着显著的差别:在一些治疗敏感的个体，肿瘤甚至可以完全消退，达到临床完全缓解甚至病理完全缓解；而在治疗不敏感的一部分病人中，在术前放化疗的过程中即出现肿瘤进展，对于这部分患者，术前放化疗可能使患者错过了最佳的手术时机。如果能在局部进展期直肠癌患者中挑选出潜在对于新辅助放化疗受益的患者，那将更大程度上使这部分患者受益。局部进展期直肠癌对于术前放化疗的敏感性受多方面的影响，例如治疗前血CEA水平，肿瘤组织中EGFR水平、微卫星状态及免疫微环境等，本文对近年来相关文献中直肠癌术

5、前放化疗敏感性预测的相关因素以及目前存在的问题和研究进展进行综述。关键词：局部进展期直肠癌，新辅助放化疗，敏感性预测因素，肿瘤免疫微环境，肿瘤消退分级1英文摘要AdvancesofprognosticfactorsofneoadjuvantchemoradiotherapysensitivityinlocallyadvancedrectalcancerABSTRACTRectalcancer(T1/2,orN0)intheearlystagecanbecuredbyTMEsurgery,witha5-yearsurvivalrateof90%ormore.Asforthe

6、locallyadvancedrectalcancer(T3/4,orN+),itisthefirstchoiceathomeandabroadtoconductthepreoperativeconcurrentchemoradiationplusTMEsurgerypluspostoperativeadjuvanttreatmentduetothehighrateoflocalrecurrenceofdirectTMEsurgery,failuretoretaintheanus,failuretodoradicalresection(R0),etc.Thepreoper

7、ativeconcurrentchemoradiotherapyhasmanyadvantagesforlocallyadvancedrectalcancer,suchasreducingtumorvolume,reducinglocaltumorstaging,increasingthepossibilityofR0resection,reducingradiationtoxicity,increasingtherateofanalpreserving,reducinglocalrecurrencerate,andsoon.