Microsatellite-stable (MSS) or mismatch repair-proficient (pMMR) metastatic colorectal cancer (mCRC) responds poorly to immune checkpoint inhibitors (ICIs). We investigated whether combining ICIs with radiotherapy (RT) promotes distant tumor regression and improves survival. We retrospectively analyzed patients with MSS/pMMR mCRC treated with ICIs between October 2021 and November 2024. According to RT use, patients were divided into RT and non-RT (NRT) groups. Propensity score matching (PSM) was used to minimize selection bias. The primary endpoint was the out-of-field (abscopal) response rate (ARR) per Response Evaluation Criteria in Solid Tumors version 1.1. Secondary endpoints included overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (TRAEs), graded using Common Terminology Criteria for Adverse Events version 5.0. After PSM, 40 matched pairs were generated from the RT (n = 46) and NRT (n = 83) groups. ARR was higher in the RT group than in the NRT group (22.5

Background Anus preservation has been a challenge in the treatment of patients with low rectal adenocarcinoma (within 5 cm from the anal verge) because it is difficult to spare the anus with its functioning sphincter complex under the safe margin of tumour resection. Patients with dMMR/MSI-H can achieve a favourable complete response (CR) rate by using a single immune checkpoint inhibitor. For patients with pMMR/MSS/MSI-L, intensified neoadjuvant three-drug chemotherapy may be the preferred option for anal preservation. In addition, the watch and wait (W&W) strategy has been proven safe and feasible for patients with rectal cancer who achieve a clinical complete response (cCR). Therefore, we initiated this clinical trial to explore the optimal neoadjuvant treatment pattern for patients with low locally advanced rectal cancer (LARC) with different MMR/MSI statuses, aiming to achieve a higher cCR rate with the W&W strategy and ultimately provide more patients with a chance of anus preservation. Methods This is a randomised, controlled, open-label, multicentre phase III trial. Patients with clinical stage T2-4 and/or N + tumours located within 5 cm from the anal verge are considered eligible. Based on the results of pathological biopsy, the patients are divided into two groups: dMMR/MSI-H and pMMR/MSS. Patients in the dMMR/MSI-H group will be randomly allocated in a 1:1 ratio to either arm A (monoimmunotherapy) or arm B (short-course radiotherapy followed by monoimmunotherapy). Patients in the pMMR/MSS group will be initially treated with long-term pelvic radiation with concurrent capecitabine combined with irinotecan. Two weeks after the completion of chemoradiotherapy (CRT), the patients will be randomly allocated in a 1:1 ratio to arm C (XELIRI six cycle regime) or arm D (FOLFIRINOX nine cycle regime). The irinotecan dose will be adjusted according to the UGT1A1-genotype. After treatment, a comprehensive assessment will be performed to determine whether a cCR has been achieved. If achieved, the W&W strategy will be adopted; otherwise, total mesorectal excision (TME) will be performed. The primary endpoint is cCR with the maintenance of 12 months at least, determined using digital rectal examination, endoscopy, and rectal MRI or PET/CT as a supplementary method. Discussion APRAM will explore the best anus preservation model for low LARC, combining the strategies of consolidation chemotherapy, immunotherapy, and short-course radiotherapy, and aims to preserve the anus of more patients using W&W. Our study provides an accurate individual treatment mode based on the MMR/MSI status for patients with low LARC, and more patients will receive the opportunity for anus preservation under our therapeutic strategy, which would transform into long-term benefits. Trial registration Clinicaltrials.gov NCT05669092 (Registered 28th Nov 2022).

Background The heterogeneity of colorectal cancer (CRC) is the main cause of the disparity of drug sensitivity and the variability of prognosis. Pyroptosis is closely associated with the development and prognosis of various tumors, including CRC. Dividing CRC into distinct subgroups based on pyroptosis is a worthwhile topic for improving the precision treatment and prognosis prediction of CRC. Methods We classified patients into two clusters using the consensus clustering based on the pyroptosis-related genes (PRGs). Next, the prognostic signature was developed with LASSO regression analysis using the screened genes from differentially expressed genes (DEGs) by univariate and multivariate Cox analyses. According to the pyroptosis-related score (PR score) calculated with the signature, patients belonged to two groups with distinct prognosis. Moreover, we assessed the immune profile to explore the relationship between the signature and immunological characteristics. Two single cell sequencing databases were adopted for further exploration of tumor immune microenvironment (TME). In addition, we applied our own cohort and Drugbank to explore the correlation of the signature and clinical therapies. We also studied the expression of key genes by immunohistochemistry. Results The signature performed well in predicting the prognosis of CRC as the high area under curve (AUC) value demonstrated. Patients with a higher PR score had poorer prognosis and higher expression of immune checkpoints but more abundant infiltration of immune cells. Combining with the indicator of therapeutic analysis, they might benefit more from immune checkpoint blockade (ICB) and neo-adjuvant chemoradiotherapy (nCRT). Conclusion In conclusion, our study is based on genomics and transcriptomics to investigate the role of PRGs in CRC. We have established a prognostic signature and integrated single-cell data to study the relationship between the signature with the TME in CRC. Its clinical application in reliable prediction of prognosis and personalized treatment was validated by public and own sequencing cohort. It provided a new insight for the personalized treatment of CRC.

目的 探讨术后单纯放疗和术后放化疗治疗软组织肉瘤(STS)的临床结局和不良反应方面的差异,以及影响STS患者预后的因素.方法 回顾性分析浙江省肿瘤医院2012年5月至2019年5月首诊确诊为原发性STS的患者,术后接受辅助放疗,伴或不伴术后化疗.共入组100例患者,将其分为术后单纯放疗组(52例)与术后放化疗组(48例),中位随访时间为65个月(24～124个月).统计两组患者的无局部复发生存(LRFS)期、无远处转移生存(DMFS)期、总生存(OS)期和治疗相关不良反应.采用Kaplan-Meier法计算生存率,log-rank检验进行单因素分析,Cox模型行多因素分析.结果 多因素分析显示,肿瘤最长径是肿瘤局部复发的独立预测因素(HR=4.80,95％CI=1.16～19.85,P=0.031),同时也是远处转移(HR=4.67,95％CI 为 1.53～14.26,P=0.007)和患者 OS 期(HR=4.10,95％CI为1.35～12.48,P=0.013)的独立预测因素.另外,接受放化疗患者的骨髓抑制程度显著高于单纯放疗患者(P＜0.001).结论 在患者样本量有限的情况下,与单纯放疗相比,放化疗在远处转移或生存率方面没有改善,不良反应增加,但总体耐受性尚好.有必要进行大规模人群的前瞻性随机研究,并对组织学亚型进行亚组分析,以确保获得更有参考价值的结果.

MIRAGE是一项前瞻性、随机对照、单中心Ⅲ期优效性研究,该研究旨在确定MRI引导下的计划靶区外扩边界缩减能否显著降低前列腺癌体部立体定向放疗(stereotactic body radiotherapy,SBRT)患者中度毒性反应发生率,次要研究终点包括急性2度及以上胃肠道毒性反应以及患者报告生活质量评分的动态变化.因期中分析显示主要研究终点已提前达到预设统计检验水准,故研究提前中止招募,最终纳入156例患者(CT引导组77例,MRI引导组79例).分析结果显示,MRI引导组的急性2度及以上泌尿生殖毒性反应发生率显著低于CT引导组(24.4％vs 43.4％,P=0.01).此外,急性2度及以上胃肠道毒性反应发生率以及部分患者报告生活质量结局指标也显示MRI引导组优于CT引导组.因此,MRI引导相比较于CT引导的前列腺SBRT,能显著降低患者中度急性毒性反应和提高患者报告生活质量,但能否持续获益仍需长期随访结果来确认.

Background:Local recurrence of colorectal cancer is associated with poor prognosis and quality of life. For patients not eligible for curative surgery, chemoradiation could be a promising therapeutic option, but there is no consensus yet for the concurrent chemotherapy regimen. This study evaluated the effects and safety of intensity-modulated radiation therapy (IMRT) when administered concurrently with raltitrexed and irinotecan to patients with unresectable recurrent colorectal cancer.Methods:Eligible patients developed unresectable recurrent colorectal cancer, and were refractory to, or intolerant of, chemotherapy with fluoropyrimidine and oxaliplatin. IMRT was delivered (total dose: 50-60 Gy in 25-30 fractions) concurrently with irinotecan and raltitrexed (200 and 3 mg/m2, respectively, on days 1 and 22). After treatment completion, patients underwent surgery or continued the same regimen of chemotherapy and were assessed by a multidisciplinary team. The primary endpoint was the objective response rate, defined as the proportion of patients with a confirmed complete response or partial response, assessed by radiologist and investigator after the completion of radiotherapy and reconfirmed a month later, in accordance with the Response Evaluation Criteria in Solid Tumors version 1.1.Results:All 30 patients enrolled in this study between January 2019 and July 2020 completed radiotherapy and received a median of five chemotherapy cycles (range, 2-10 cycles). Twelve patients (40.0%) experienced an objective response (two complete responses and ten partial responses) and 17 patients exhibited stable disease [disease control rate (DCR): 96.7%]. The median follow-up was 22 months (range, 4-35 months), by the end of follow-up, six (20.0%) patients had local failure in the irradiation field, four (13.3%) had regional progression outside the irradiation field, 13 (43.3%) had distant metastasis or metastatic progression and nine (30.0%) died. The median progression-free survival (PFS) and local PFS (LPFS) were 13.5 and 23 months, respectively. The incidence of grade 3 or 4 adverse events was 26.7%, the most common of which was neutropenia (13.3%).Conclusions:IMRT with concurrent raltitrexed and irinotecan is a feasible treatment for unresectable recurrent colorectal cancer, which allows good tumor response and local control with acceptable toxicity profile.

目的 探讨局部晚期直肠癌(LARC)患者术前同步放射治疗及化学治疗联合热疗的临床疗效.方法 选取2009年7月至2013年12月在浙江省肿瘤医院确诊为LARC(美国癌症联合委员会分期T3～T4伴或不伴淋巴结转移)的67例患者为研究对象,行术前新辅助放射治疗及化学治疗联合热疗,放射治疗总剂量为50 Gy,放射治疗前1 h内进行热疗(每周2次),持续5周.放射治疗结束4～6周后对LARC患者进行手术治疗.对所有患者的临床疗效进行评价,并采用Kaplan-Meier绘制生存曲线进行分析.结果 67例患者中共64例患者接受手术治疗,且均恢复顺利出院;余3例因拒绝切除肛门而放弃手术治疗.96.9％(62/64)的患者达到R0切除,89.1％(57/64)的患者出现局部降期,23.4％(15/64)的患者病理完全缓解(pCR),76.6％(49/64)的患者病理示无淋巴结转移(ypN-),Ⅲ级不良反应发生率为14.9％(10/67).术后随访3～72个月,5年总生存率为81.2％(52/64),5年肿瘤无病生存率为70.3％(45/64).同时,pCR患者的生存曲线明显优于非pCR患者(χ2=4.132,P=0.042),ypT0～T2患者的生存曲线明显优于ypT3～T4患者(χ2=14.791,P<0.001),ypN-患者的生存曲线明显优于ypN+患者(χ2=12.402,P<0.001).结论 新辅助放射治疗及化学治疗联合热疗治疗LARC可以显著提高LARC患者的pCR、R0切除率及保肛率,肿瘤退缩明显,且不会增加治疗相关不良反应,患者耐受性较好.

Colorectal cancer (CRC) is one of the most common types of malignancy and the third most commonly diagnosed form of cancer worldwide, ranking as the fourth leading cause of cancer-associated mortality. MicroRNA (miR)-576-5p has been reported to be highly expressed in patients with CRC; however, its biological role remains unclear. The present study aimed therefore to investigate the biological role and underlying mechanism of miR-576-5p in CRC cell line SW480. The viability of SW480 cells following transfection with miR-576-5p mimic or inhibitor was analyzed using MTT assay. Wound healing and Transwell assays were performed to determine the cell migratory and invasive abilities, respectively. A dual luciferase reporter assay was used to verify the predicted binding site between miR-576-5p and Wnt5a. Reverse transcription-quantitative PCR and western blotting were used to analyze the expression levels of miR-576-5p, E-cadherin, N-cadherin, vimentin, Snail1, Wnt5a, beta-catenin, c-myc, cyclin D1 and p/t-c-Jun. Using bioinformatics analysis, high expression of miR-576-5p was found not only in tumor tissues, compared with the normal tissue, but also in CRC cells, compared with NCM460 cells. Furthermore, the inhibition of miR-576-5p expression significantly decreased the cell viability and the migratory and invasive abilities of SW480 cells, and suppressed the epithelial-to-mesenchymal transition (EMT). In addition, miR-576-5p could interact with Wnt5a and regulate the expression level of Wnt5a in order to influence the activity of Wnt/beta-catenin signaling. The results from rescue experiments further demonstrated that the effect of miR-576-5p overexpression on cell metastasis and EMT was reversed by Wnt5a overexpression or treatment with XAV-939, which is an inhibitor of the Wnt/beta-catenin signaling pathway. In conclusion, the findings from the present study suggested that inhibition of miR-576-5p may suppress SW480 cell metastasis and EMT by targeting Wnt5a and regulating the Wnt5a-mediated Wnt/beta-catenin signaling pathway, providing a potential therapeutic target for the treatment of CRC.

Objective:To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer.Methods:A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman′ s correlation analysis. Results:The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman′ s correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity ( r=0.26, P<0.05; r=0.31, P<0.01), upper gastrointestinal toxicity ( r=0.51, P<0.01; r=0.63, P<0.01), proctitis ( r=0.23, P<0.05; r=0.45, P<0.01) and fatigue ( r=0.47, P<0.01; r=0.64, P<0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage Ⅱ-Ⅲ B, age<65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P<0.05). Conclusions:Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy.

Objective: Optimal approaches to patients with local recurrence of rectal cancer are unclear in China. This study aimed to evaluaty-30te the clinical outcomes and toxicity associated with different treatment regimens for patients with local recurrence of rectal cancer. Methods: A retrospective chart review of patients with local recurrence of rectal cancer and previous radical surgical treatment between March 2010 and December 2017 with curative intent was performed. Disease-related endpoints included treatment progression-free survival (PFS) and overall survival (OS) using the Kaplan-Meier method. Toxicities were assessed using Common Terminology Criteria for Adverse Events, version 5.0, and complications were scored according to the Clavien-Dindo classification. Results: A total of 71 patients met the inclusion criteria in this study. The recurrence sites were mainly local recurrence in the pelvic cavity and regional lymph node metastasis. Twenty patients received chemoradiotherapy combined with surgery, 10 underwent surgery alone, and others received chemoradiotherapy-alone (n = 27) and chemotherapy-alone (n = 14) treatment. A clear difference was found in PFS between surgery/chemoradiotherapy with surgery and chemoradiotherapy/chemotherapy groups (26.6 months vs 14.1 months, P = 0.033). The PFS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 65.2 months, 20.2 months, and 14.2 months, respectively (P = 0.042). The multivariate analysis of PFS demonstrated that surgery was an independent factor. The proportion of patients with distant metastases after chemoradiotherapy/chemotherapy was higher than that of patients undergoing surgery (36.6% vs 21.4%, P = 0.179). The OS of patients in the surgery combined with chemoradiotherapy, surgery alone, and chemotherapy/chemoradiotherapy groups was 89.4 months, 66.0 months, and 62.8 months, respectively (P = 0.189). Radiation treatment and surgery did not increase extra severe toxicities. Conclusion: Surgery combined with chemoradiotherapy was a beneficial treatment mode for managing patients with locally recurrent, nonmetastatic rectal cancer. It was associated with better local disease control, no increase in toxicity, and prolonged survival among patients with locally recurrent rectal cancer.

[目的]研究miR-519b-3p表达与局部晚期直肠癌术前放化疗应答的相关性,并探讨miR-519b-3p是否通过靶向作用ARID4B提高局部晚期直肠癌患者术前放化疗的反应性.[方法]实时定量PCR检测局部晚期直肠癌患者miR-519b-3p的表达水平,用miR-519b-3p模拟物或抑制剂转染HCT116或SW480细胞,体外验证其表达水平与放化疗反应的相关性;双荧光素酶报告实验用于检测miR-519b-3p与ARID4B之间的相互作用;通过重组质粒构建及细胞转染调节相关基因在细胞内的表达,通过建立裸鼠异位移植瘤模型,在体验证miR-519b-3p对ARID4B的调节作用.[结果]实验发现miR-519b-3p表达与局部晚期直肠癌患者对pCRT的反应性相关,miR-519b-3p在局部晚期直肠癌应答患者中呈现为高表达.miR-519b-3p的过表达增强了体外放化疗的反应性.在机理上,我们发现miR-519b-3p直接与ARID4B mRNA的3'UTR结合,其表达与miR-519b-3p表达呈负相关.功能实验显示miR-519b-3p以ARID4B依赖方式直接与直肠癌患者对术前放化疗的反应密切相关.[结论]miR-519b-3p通过靶向作用ARID4B提高局部晚期直肠癌患者术前放化疗的反应性.

Malnutrition is the most common complication of lung cancer patients. The purpose of this study was to investigate the nutritional indicators and quality of life of patients with locally advanced non-small cell lung cancer (NSCLC) who received definitive radiotherapy, to compare the nutritional status and quality of life of male and female patients, and to explore the relationship between them. Patients with locally advanced NSCLC who received definitive radiotherapy in our hospital were enrolled. The quality of life of patients was assessed by the Cancer Therapeutic Function Scale. Height, weight and body composition were collected by Inbody 230. Nutritional indicators such as albumin and hemoglobin were recorded within a week. Between January 2018 and March 2018, ninety-six male patients and 32 female patients were enrolled. The BMI of 7.3% of male patients was lower than 18.5 kg/m2, and that of all female patients was more than 18.5 kg/m2. The proportion of male patients with hypoalbuminemia was equal to that of female patients, accounting for 65.6% of the total number. 6.3% of male patients with hypoalbuminemia and BMI were lower than 18.5 kg/m2 at the same time. The proportion of male patients with anemia was higher than that of female patients (χ2 = 7.626, P = 0.006), and the skeletal muscle and water content were higher than those of female patients (T = 5.653, P = 0.000; T = 8.184, P = 0.000). Body mass index, fat content, skeletal muscle content and water content in male patients were positively correlated with quality of life (β = 0.225, P = 0.046; β= 0.232, P = 0.042; β = 0.291, P = 0.009; β= 0.328, P = 0.004), while there was no significant correlation between nutritional indicators and quality of life score in female patients. Protein malnutrition is the main type of malnutrition in lung cancer patients, the manifestation is that body weight is maintained in normal range or even overweight, but serum albumin, lymphocyte count and other indicators are abnormal. However, some male patients are suffer from mixed malnutrition, the consumption of weight and decrease of serum nutritional indicators both occurred, which is a serious life-threatening malnutrition. So, male patients with lung cancer are more likely to suffer from serious malnutrition than female patients, and malnutrition has a greater impact on the quality of life of male patients.

Recent evidences demonstrate that preoperative chemoradiotherapy (pCRT) followed by mesorectal excision is an effective therapy for patients with locally advanced rectal cancer (LARC). Nevertheless, the predictive molecular biomarkers for the response of patients to CRT remain largely unknown. Here we showed that the expression of miR-519b-3p was correlated with the responsiveness to pCRT in patients with LARC. We found that miR-519b-3p was highly expressed in responsive LARC samples. And we showed that miR-519b-3p may serve as a novel predictive marker by ROC analysis. In addition, overexpression of miR-519b-3p enhanced responsiveness to chemoradiation in vitro. Mechanistically, we found that miR-519b-3p directly bond to the 3' UTR of ARID4B mRNA whose expression was inversely correlated with miR-519b-3p expression. Finally, we performed functional experiments and showed that miR-519b-3p was directly involved in response to pCRT in rectal cancer patients in an ARID4B-dependent way.

Much progress has been made in the diagnosis and treatment of Hodgkin's lymphoma, which has become a highly curable malignancy.However, prolonged survival makes clinicians pay more attention to long-term toxicities of treatment.Consequently, individualized treatment based on disease stage and risk factors is a research hotspot at present.This article reviews recent advances in the individualized treatment of early-stage classical Hodgkin's lymphoma.

Background: Increasing evidence suggests that cancer-associated inflammation is associated with poorer outcomes. The neutrophil- to-lymphocyte ratio (NLR), considered as a systemic inflammation marker, is thought to predict prognoses in colorectal cancer. In this study, we explored the association between the NLR and prognoses following neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC).Material/Methods: From February 2002 to December 2012, a group of 202 patients diagnosed with LARC and receiving neoadjuvant CRT followed by radical surgery was included in our retrospective study. The associations between the pre-CRT NLR and clinicopathological characteristics, as well as the predictive value of pre-CRT NLR against survival outcomes, were analyzed.Results: The average NLR was 2.7 +/- 1.5 (median 2.4, range 0.6-12.8). There were 63 (31.2%) patients with NLR >= 3.0, and 139 (68.8%) patients with NLR < 3.0. Correlation analyses showed that no clinicopathological characteristics except age were associated with NLR. We did not find an association between NLR and survival outcomes. In multivariate Cox model analyses, the R1/R2 resection, lymph node ratio >= 0.1, and perineural/lymphovascular invasion were independently associated with worse disease-free survival and overall survival.Conclusions: In our cohort, the NLR did not correlate with survival outcomes in LARC patients undergoing neoadjuvant CRT. The prognostic value of NLR should be validated in large-scale prospective studies.

目的 探讨直肠癌新辅助放化疗前后血清癌胚抗原(CEA)变化情况与肿瘤降期的相关性.方法 收集71例直肠癌患者病历资料,将患者分为治疗前CEA阳性和治疗前CFA阴性,分析两类患者新辅助放化疗前后CEA及CEA比值和肿瘤降期之间的相关性.结果 71例患者治疗前CEA与肿瘤降期无相关性(P＞0.05),放化疗后CEA与肿瘤降期之间呈负相关(均P＜ 0.05);29例治疗前CEA阴性患者,无论是放化疗后CEA,还是CEA比值与肿瘤降期均无相关性(均P＞ 0.05);42例治疗前CEA阳性患者,放化疗后CEA与肿瘤降期之间呈负相关(P＜0.05),而CEA比值与肿瘤降期无相关性(P＞0.05),放化疗后CEA预测肿瘤降期的准确性接近中等,临界值为2.05 ng/ml.结论 新辅助放化疗后CEA在预测肿瘤降期时优于放化疗前CEA;治疗前CEA阴性患者的CEA值及CEA变化情况在预测肿瘤降期时的作用尚不明确;对于治疗前CEA阳性患者,放化疗后CEA值在预测肿瘤降期时优于放化疗前后CEA比值.

目的 探讨可手术结直肠癌患者的术前系统性炎症指标与临床病理特征的相关性.方法 回顾300例行根治手术的结直肠癌患者,分析患者术前的中性粒细胞计数、淋巴细胞计数、血小板计数、中性粒细胞-淋巴细胞比例(NLR)、血小板-淋巴细胞比例(PLR)、血清白蛋白、血清C反应蛋白(CRP)、Glasgow预后分数(GPS)、血浆纤维蛋白原与临床病理特征之间的相关性.结果 中性粒细胞计数(P=0.000)、血小板计数(P=0.000)、NLR(P =0.000)、PLR(P =0.000)、白蛋白(P =0.000)、血清CRP(P =0.015)、Glasgow预后分数(P=0.000)、纤维蛋白原(P =0.000)在不同瘤体患者中比较差异有统计学意义;NLR(P =0.042)、PLR(P =0.000)、白蛋白(P=0.02)、纤维蛋白原(P=0.001)在不同T分期患者中比较差异有统计学意义.PLR(r =0.188,P=0.001)和纤维蛋白原(r =0.182,P=0.002)与T分期的相关系数最高,血清CRP(r =0.318,P=0.000)和纤维蛋白原(r=0.301,P=0.000)与瘤体大小的相关系数最高.结论 肿瘤负荷是影响结直肠癌患者系统性炎症程度的重要因素,通过术前PLR、血清CRP、纤维蛋白原等系统性炎症指标能初步评估肿瘤大小及T分期.

直肠癌局部复发仍是临床棘手的难题，治疗往往需要多学科参与。本综述着重探讨近年来直肠癌局部复发的诊断与治疗进展，为临床实践提供指导建议。

ObjectiveTo explore the incidence and influential factors of acute hematologic toxicity in elderly rectal cancer patients treated with pelvic radiotherapy.MethodsFifty elderly patients aged 75 and older with rectal cancer, who were treated with pelvic radiotherapy at our hospital, were retrospectively analyzed. 111 non-elderly patients under 75 years of age, who were treated with pelvic radiotherapy in the same period, were selected as a control group. The relationship between clinical characteristics and incidence of grade 3~4 hematologic toxicity were analyzed by using chi-square test and multinomial logistic regression. ResultsIn the elderly patient group, the incidence of grade 0, grade 1~2, grade 3~4 hematologic toxicity were 6.0%, 78.0%, and 16.0%, respectively. In the non-elderly patient group, the incidence of grade 0, grade 1~2, grade 3~4 hematologic toxicity were 24.3%, 68.5%, and 7.2%, respectively. The incidence of grade 3~4 hematologic toxicity in elderly patients was higher than that in non-elderly patients (P=0.009). Multivariate analysis showed that the body mass index was significantly correlated with the incidence of grade 3~4 hematologic toxicity in elderly patients (P=0.038).ConclusionsAcute hematologic toxicity induced by pelvic radiotherapy was well tolerated in elderly patients with rectal cancer. High body mass index may be associated with severe hematologic toxicity in elderly patients.