Department of Colon and Rectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Dis Colon Rectum. 2010 Mar;53(3):251-6. doi: 10.1007/DCR.0b013e3181bcd3cc.
Preoperative chemoradiotherapy can lead to pathologic complete response of rectal cancer. This study was designed to determine the relationship between postchemoradiotherapy pathologic T stage (ypT stage) and nodal metastases and to evaluate whether pathologic complete response of the primary tumor results in sterilization of mesorectal lymph nodes.
Clinicopathological data from 1997 to 2007 of a prospectively maintained colorectal cancer database were examined. Inclusion criteria were patients with extraperitoneal rectal cancer who underwent preoperative chemoradiotherapy and subsequent radical resection. Statistical analysis was performed by use of Kruskall-Wallis and Wilcoxon rank-sum tests.
Two hundred forty-two patients were identified (73.1% male, median age, 57 y (range, 36-85 y)). Data regarding preoperative chemoradiotherapy were available for 177 patients (73.1%). The median dose of radiotherapy was 5040 cGy (3060-6100 cGy). The mean preoperative radiotherapy dose and interval between chemoradiotherapy and surgery are similar when stratified by ypT stage (P = .55 and P = .72, respectively). Low anterior resection was performed in 174 patients (71.6%), and the remainder underwent abdominoperineal resection. A mural pathologic complete response was achieved in 62 patients (25.6%). In this pathologic complete-response group, positive lymph nodes were found in 2 patients (3.2%). The rate of metastatic lymph nodes increased as ypT stage increased (ypT1 = 11.1%, ypT2 = 29.2%, ypT3 = 37.3%).
Patients with a mural pathologic complete response have a low rate of positive lymph nodes. These findings may have implications for the management strategies of these patients, including the use of local resection or a watch-and-wait policy. When the response to chemoradiotherapy is not complete, radical surgery should remain the treatment based on high rates of lymph node involvement.
术前放化疗可使直肠癌达到病理完全缓解。本研究旨在确定放化疗后病理 T 分期（ypT 分期）与淋巴结转移的关系，并评估原发肿瘤的病理完全缓解是否导致直肠系膜淋巴结的灭菌。
对 1997 年至 2007 年前瞻性维护的结直肠数据库的临床病理数据进行了检查。纳入标准为接受术前放化疗和根治性切除术的腹膜外直肠癌患者。采用 Kruskal-Wallis 和 Wilcoxon 秩和检验进行统计学分析。
共确定了 242 例患者（73.1%为男性，中位年龄为 57 岁[范围为 36-85 岁]）。177 例（73.1%）患者有术前放化疗的数据。放疗中位剂量为 5040cGy（3060-6100cGy）。按 ypT 分期分层时，术前放疗剂量和放化疗与手术间隔的平均值相似（P=.55 和 P=.72）。174 例患者行低位前切除术，其余患者行腹会阴联合切除术。62 例（25.6%）患者获得了壁内病理完全缓解。在这组病理完全缓解的患者中，有 2 例（3.2%）发现阳性淋巴结。ypT 分期越高，阳性淋巴结的比例越高（ypT1=11.1%，ypT2=29.2%，ypT3=37.3%）。
壁内病理完全缓解的患者阳性淋巴结的比例较低。这些发现可能对这些患者的管理策略有影响，包括局部切除或观察等待策略的应用。当放化疗反应不完全时，根治性手术仍应基于淋巴结受累率高的治疗。
