Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Honjo, Kumamoto, Japan.
Int J Clin Oncol. 2010 Feb;15(1):70-6. doi: 10.1007/s10147-009-0013-5. Epub 2010 Jan 21.
The combination of chemotherapy and surgery holds promise for improving CRC patient prognosis. We evaluated the pathological impact of chemotherapy on primary lesions and lymph node (LN) metastases retrospectively.
Sixteen CRC patients with synchronous liver metastasis underwent a radical operation between March 2005 and August 2007. Eight of the 16 cases (surgery group) were operated on for the primary lesion without chemotherapy and another 8 cases (chemotherapy group) were operated on after chemotherapy with FOLFOX (median: 8 courses).
Five of the 8 patients in the surgery group were found to have pathological LN metastasis (62.5%; N0 37.5%, N1 37.5%, N2 25%). However, only 2 of the 8 patients in the chemotherapy group were found to have LN metastasis (25%; N0 75%, N1 25%, N2 0%). The ratio of LN metastasis (number of metastatic LNs/resected LNs in total) was 11.1% in the surgery group, but it was 4.8% in the chemotherapy group. Necrotic areas were widely detected in the LN specimens of the chemotherapy group. The percentage of lymphatic (ly) and vascular (v) invasion in the primary lesions was smaller in the chemotherapy group (ly 12.5% vs. 25.0%) than in the surgery group (ly 62.5% vs. 50.0%). The patients in the chemotherapy group had no significant adverse effects and did not show an worse survival rate overall than the surgery group.
A promising effect of chemotherapy on the status of LN metastasis and vessel invasions at the primary site was observed in the patients who responded to FOLFOX.
化疗与手术的联合应用有望改善 CRC 患者的预后。我们回顾性评估了化疗对原发灶和淋巴结（LN）转移的病理影响。
2005 年 3 月至 2007 年 8 月，16 例 CRC 合并同步肝转移患者接受根治性手术。其中 8 例（手术组）未接受化疗即行原发灶手术，另 8 例（化疗组）在接受 FOLFOX 化疗后（中位数：8 个疗程）行手术。
手术组 8 例患者中有 5 例（62.5%；N0 37.5%，N1 37.5%，N2 25%）发现有病理 LN 转移。然而，化疗组 8 例患者中仅有 2 例（25%；N0 75%，N1 25%，N2 0%）发现有 LN 转移。手术组的 LN 转移率（转移的淋巴结数/切除的总淋巴结数）为 11.1%，而化疗组为 4.8%。化疗组的 LN 标本中广泛存在坏死区。原发灶淋巴管（ly）和血管（v）侵犯的比例在化疗组较小（ly 12.5% vs. 25.0%），而在手术组较大（ly 62.5% vs. 50.0%）。化疗组患者无明显不良反应，总生存率与手术组无显著差异。
对 FOLFOX 反应良好的患者中，化疗对 LN 转移和原发灶血管侵犯的状态有明显的治疗作用。
