日本一项关于低位直肠癌侧方盆淋巴结转移的全国多机构研究结果：是区域性疾病还是远处疾病？

Results of a Japanese nationwide multi-institutional study on lateral pelvic lymph node metastasis in low rectal cancer: is it regional or distant disease?

机构信息

Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.

出版信息

Ann Surg. 2012 Jun;255(6):1129-34. doi: 10.1097/SLA.0b013e3182565d9d.

DOI:10.1097/SLA.0b013e3182565d9d

PMID:22549752

Abstract

OBJECTIVE

To evaluate whether lateral pelvic lymph nodes (LNs) in low rectal cancer are metastatic disease or part of regional LNs that are amenable to curative resection.

BACKGROUND

It is highly controversial whether lateral pelvic LNs should be considered as regional or distant disease, although the American Joint Committee on Cancer (AJCC) defines internal iliac LNs as regional LNs of rectal cancer.

METHODS

Data of patients with stage I to III low rectal cancer who underwent curative resection from 1978 to 1998 were extracted from the multi-institutional registry of large bowel cancer in Japan. Patients with only mesorectal LN metastasis were classified as the mesorectal-LN group. Patients with lateral pelvic LN metastasis localized to or extending beyond the internal iliac area were classified as the internal lateral pelvic lymph nodes (LPLN) group and external-LPLN group, respectively. Overall survival (OS) and cancer-specific survival (CSS) were compared between the groups.

RESULTS

Lateral pelvic LN dissection was performed in 5789 (50%) of 11,567 patients. Overall, 3905 (34%), 411 (3.6%), and 244 (2.1%) patients were classified as the mesorectal-LN, internal-LPLN, and external-LPLN groups, respectively. When the mesorectal LN group was subdivided as defined by the AJCC, both 5-year OS and CSS were not significantly different between the N2a and internal-LPLN groups (OS: 45% vs 45%, P = 0.9585; CSS: 51% vs 49%, P = 0.5742), and the N2b and external-LPLN groups (OS: 32% vs 29%, P = 0.3342; CSS: 37% vs 34%, P = 0.4347). OS and CSS were significantly better in the external-LPLN group than in stage IV patients who underwent curative resection (OS: 29% vs 24%, P = 0.0240; CSS: 34% vs 27%, P = 0.0117).

CONCLUSIONS

Lateral pelvic LNs can be considered as regional LNs in low rectal cancer, although metastasis extending beyond the internal iliac area is associated with poorer survival.

摘要

目的

评估低位直肠癌的侧盆淋巴结（LNs）是否为转移性疾病，还是可通过根治性切除治愈的局部淋巴结的一部分。

背景

尽管美国癌症联合委员会（AJCC）将髂内淋巴结定义为直肠癌的局部区域淋巴结，但侧盆 LNs 是否应被视为局部或远处疾病仍存在很大争议。

方法

从日本大肠多机构登记处提取了 1978 年至 1998 年接受根治性切除术的 I 至 III 期低位直肠癌患者的数据。只有直肠系膜淋巴结转移的患者被归类为直肠系膜淋巴结组。侧盆淋巴结转移局限于或超出髂内区域的患者分别归类为内部侧盆淋巴结（LPLN）组和外部 LPLN 组。比较各组的总生存率（OS）和癌症特异性生存率（CSS）。

结果

5789（50%）名 11567 名患者接受了侧盆 LN 清扫术。总体而言，3905（34%）、411（3.6%）和 244（2.1%）名患者分别被归类为直肠系膜淋巴结、内部 LPLN 和外部 LPLN 组。当直肠系膜淋巴结组按 AJCC 定义进一步细分时，N2a 与内部 LPLN 组之间的 5 年 OS 和 CSS 均无显著差异（OS：45% vs 45%，P=0.9585；CSS：51% vs 49%，P=0.5742），N2b 与外部 LPLN 组之间也无显著差异（OS：32% vs 29%，P=0.3342；CSS：37% vs 34%，P=0.4347）。与接受根治性切除术的 IV 期患者相比，外部 LPLN 组的 OS 和 CSS 明显更好（OS：29% vs 24%，P=0.0240；CSS：34% vs 27%，P=0.0117）。