侧方淋巴结转移是接受术前放化疗及根治性切除的直肠癌局部区域复发的主要原因。

Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection.

作者信息

Kim Tae Hyun, Jeong Seung-Yong, Choi Dong Hyun, Kim Dae Yong, Jung Kyung Hae, Moon Sung Ho, Chang Hee Jin, Lim Seok-Byung, Choi Hyo Seong, Park Jae-Gahb

机构信息

Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.

出版信息

Ann Surg Oncol. 2008 Mar;15(3):729-37. doi: 10.1245/s10434-007-9696-x. Epub 2007 Dec 5.

DOI:10.1245/s10434-007-9696-x

PMID:18057989

Abstract

BACKGROUND

In rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection, we evaluated the effect of clinical parameters on lateral pelvic recurrence and made an attempt to identify a risk factor for lateral pelvic recurrence.

METHODS

The study involved 366 patients who underwent preoperative CRT and curative resection between October 2001 and December 2005. Clinical parameters such as gender, age, tumor size, histologic type, cT and cN classification, ypT and ypN classification, circumferential resection margin, tumor regression grade, chemotherapeutic regimen, and lateral lymph node size were analyzed to identify risk factors associated with lateral pelvic recurrence.

RESULTS

Of the 366 patients, 29 patients (7.9%) had locoregional recurrence: 6 (20.7%) with central pelvic recurrence and 24 (82.7%) had lateral pelvic recurrence, of which 1 had simultaneous central and lateral pelvic recurrence. Multivariate analysis showed that ypN classification and lateral lymph node size were significantly associated with lateral pelvic recurrence (P < .001). Of 250 ypN0 patients, lateral pelvic recurrence developed in 1.4%, 2.9%, and 50% of patients with lateral lymph node sizes of < 5, 5-9.9, and > or = 10 mm, respectively (P < .001). Of 116 ypN+ patients, lateral pelvic recurrence developed in 4.3%, 35.7%, and 87.5% of patients with lateral lymph node sizes of < 5, 5-9.9, and > or = 10 mm, respectively (P < .001).

CONCLUSIONS

In our study, lateral pelvic recurrence was a major cause of locoregional recurrence, and ypN+ and lateral lymph node size were risk factors for lateral pelvic recurrence.

摘要

背景

在接受术前放化疗（CRT）及根治性切除的直肠癌患者中，我们评估了临床参数对侧方盆腔复发的影响，并试图确定侧方盆腔复发的危险因素。

方法

本研究纳入了2001年10月至2005年12月期间接受术前CRT及根治性切除的366例患者。分析了性别、年龄、肿瘤大小、组织学类型、cT和cN分类、ypT和ypN分类、环周切缘、肿瘤退缩分级、化疗方案及侧方淋巴结大小等临床参数，以确定与侧方盆腔复发相关的危险因素。

结果

366例患者中，29例（7.9%）出现局部区域复发：6例（20.7%）为中央盆腔复发，24例（82.7%）为侧方盆腔复发，其中1例同时出现中央和侧方盆腔复发。多因素分析显示，ypN分类及侧方淋巴结大小与侧方盆腔复发显著相关（P <.001）。在250例ypN0患者中，侧方淋巴结大小<5、5 - 9.9及≥10 mm的患者侧方盆腔复发率分别为1.4%、2.9%及50%（P <.001）。在116例ypN+患者中，侧方淋巴结大小<5、5 - 9.9及≥10 mm的患者侧方盆腔复发率分别为4.3%、35.7%及87.5%（P <.001）。