远端直肠癌根治性手术及新辅助放化疗后切除标本中无淋巴结：这意味着什么？

Absence of lymph nodes in the resected specimen after radical surgery for distal rectal cancer and neoadjuvant chemoradiation therapy: what does it mean?

作者信息

Habr-Gama Angelita, Perez Rodrigo O, Proscurshim Igor, Rawet Viviane, Pereira Diego D, Sousa Afonso H S, Kiss Desiderio, Cecconello Ivan

机构信息

Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil.

出版信息

Dis Colon Rectum. 2008 Mar;51(3):277-83. doi: 10.1007/s10350-007-9148-5.

DOI:10.1007/s10350-007-9148-5

PMID:18183463

Abstract

PURPOSE

The number of retrieved lymph nodes during radical surgery has been considered of great importance to ensure adequate staging and radical resection. However, this finding may not be applicable after neoadjuvant therapy in which, not only is there a decrease in lymph nodes recovered, but also a subgroup of patients with absence of lymph nodes in the resected specimen.

METHODS

Patients with absence of lymph nodes were compared with patients with ypN0 disease and patients with ypN+ disease.

RESULTS

Thirty-two patients (11 percent) had absence of lymph nodes, 171 patients (61 percent) had ypN0 disease, and 78 patients (28 percent) had ypN+ disease. Patients with absence of lymph nodes had significantly lower ypT status (ypT0-1, 40 vs. 13 percent; P<0.001) and decreased risk of perineural invasion (6 vs. 21 percent; P=0.04) compared with ypN0 patients. Five-year disease-free survival (74 percent) was similar to patients with ypN0 (59 percent; P=0.2), and both were significantly better than patients with ypN+ disease (30 percent; P<0.001).

CONCLUSIONS

Absence of lymph nodes retrieved from the resected specimen is associated with favorable pathologic features (ypT and perineural invasion status) and good disease-free survival rates. In this setting, absence of retrieved lymph nodes may reflect improved response to neoadjuvant chemoradiation therapy rather than inappropriate or suboptimal oncologic radicality.

摘要

目的

根治性手术中获取的淋巴结数量对于确保充分分期和根治性切除至关重要。然而，这一发现可能不适用于新辅助治疗后，新辅助治疗不仅会使回收的淋巴结数量减少，而且在切除标本中还存在一组无淋巴结的患者。

方法

将无淋巴结的患者与ypN0疾病患者和ypN+疾病患者进行比较。

结果

32例患者（11%）无淋巴结，171例患者（61%）有ypN0疾病，78例患者（28%）有ypN+疾病。与ypN0患者相比，无淋巴结的患者ypT状态显著更低（ypT0 - 1，40%对13%；P<0.001），神经周围侵犯风险降低（6%对21%；P = 0.04）。五年无病生存率（74%）与ypN0患者（59%；P = 0.2）相似，且两者均显著优于ypN+疾病患者（30%；P<0.001）。