Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Int J Colorectal Dis. 2014 Feb;29(2):193-200. doi: 10.1007/s00384-013-1797-3. Epub 2013 Dec 10.
This study aims to determine the risk factors for lateral pelvic recurrence (LPR) in rectal cancer patients treated with neoadjuvant chemoradiotherapy (CRT) and curative surgery.
Four hundred forty-three patients treated with neoadjuvant CRT and curative surgery from October 1999 through June 2009 were analyzed. All patients underwent total mesorectal resection without lateral pelvic lymph node (LPLN) dissection. Recurrence patterns and lateral pelvic recurrence-free survival (LPFS) were evaluated relative to clinicopathologic parameters including pelvic LN status.
Median follow-up was 52 months, with locoregional recurrence in 53 patients (11.9 %). Of the 53 patients, 28 (52.8 %) developed LPR, of which eight had both central and lateral PR. Multivariate analysis showed a significant relationship between LPFS and the number of lateral pelvic LN (p = 0.010) as well as the ratio of the number of positive LN/number of dissected LN (p = 0.038). The relationship between LPFS and LPLN size had a marginal trend (p = 0.085). Logistic regression analysis showed positive relationships between LPR probability and the number of LPLN (odds ratio [OR] 1.507; 95 % confidence interval [CI] 1.177-1.929; p = 0.001) as well as LPLN size (OR 1.124; CI 1.029-1.227, p = 0.009).
LPLN ≥ 2 and a ratio of the number of positive LN/number of dissected LN > 0.3 were prognostic of poor LPFS. The prediction curve of LPR according to the number and size of LPLN could be useful for determining the benefit of additional lateral pelvic treatment.
本研究旨在确定接受新辅助放化疗（CRT）和根治性手术治疗的直肠癌患者发生侧盆复发（LPR）的风险因素。
分析了 1999 年 10 月至 2009 年 6 月期间接受新辅助 CRT 和根治性手术治疗的 443 例患者。所有患者均接受了全直肠系膜切除术，未行侧盆淋巴结（LPLN）清扫。根据盆腔淋巴结状态等临床病理参数评估复发模式和侧盆无复发生存率（LPFS）。
中位随访时间为 52 个月，53 例患者（11.9%）发生局部区域复发。53 例患者中，28 例（52.8%）发生 LPR，其中 8 例既有中央复发又有侧方复发。多因素分析显示，LPFS 与侧盆 LPN 数量（p=0.010）以及阳性淋巴结与清扫淋巴结数量比（p=0.038）显著相关。LPFS 与 LPLN 大小之间存在边缘趋势（p=0.085）。Logistic 回归分析显示，LPR 概率与 LPLN 数量（优势比[OR] 1.507；95%置信区间[CI] 1.177-1.929；p=0.001）和 LPLN 大小（OR 1.124；CI 1.029-1.227，p=0.009）呈正相关。
LPLN≥2 和阳性淋巴结与清扫淋巴结数量比>0.3 与 LPFS 不良相关。根据 LPLN 数量和大小预测 LPR 的曲线可能有助于确定额外侧盆治疗的获益。
