Oh Heung-Kwon, Kang Sung-Bum, Lee Sung-Min, Lee Soo Young, Ihn Myoung Hun, Kim Duck-Woo, Park Ji Hoon, Kim Young Hoon, Lee Kyung Ho, Kim Jae-Sung, Kim Jin Won, Kim Jee Hyun, Chang Tae-Young, Park Sung-Chan, Sohn Dae Kyung, Oh Jae Hwan, Park Ji Won, Ryoo Seung-Bum, Jeong Seung-Yong, Park Kyu Joo
Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Surg Oncol. 2014 Jul;21(7):2280-7. doi: 10.1245/s10434-014-3559-z. Epub 2014 Mar 7.
Although lateral pelvic node dissection (LPND) is recommended for rectal cancer with clinically metastatic lateral pelvic lymph nodes (LPNs), LPNs may respond to neoadjuvant chemoradiotherapy (nCRT). Our aim was to determine the optimal indication for LPND after nCRT for mid/low rectal cancer.
Of 2,263 patients with clinical stage II/III mid/low rectal cancer who were managed at three tertiary referral hospitals, 66 patients underwent curative surgery including LPND after nCRT were included in this study. Risk factors for LPN metastasis were retrospectively analyzed and oncologic outcomes determined according to LPN response to nCRT.
Persistent LPNs greater than 5 mm on post-nCRT magnetic resonance imaging were significantly associated with residual tumor metastasis, unlike responsive LPN after nCRT (short-axis diameter ≤ 5 mm) (pathologically, 61.1 % [22 of 36] vs. 0 % [0 of 30], P < 0.001). Multivariable analysis revealed post-nCRT LPN size as a significant and independent risk factor for LPN metastasis (odds ratio 2.390; 95 % confidence interval 1.104-4.069). Over a median follow-up of 39.3 months, the recurrence rate was lower in patients with responsive nodes than in patients with persistent nodes (20 % [6 of 30] vs. 47.2 % [17 of 36], P = 0.012). The 5-year overall survival and 5-year disease-free survival rates were lower in patients with persistent LPN than in patients with responsive LPN (44.6 % vs. 77.1 %, P = 0.034; 33.7 % vs. 72.5 %, P = 0.011, respectively).
In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.
虽然对于伴有临床可转移盆腔侧方淋巴结（LPNs）的直肠癌推荐行盆腔侧方淋巴结清扫术（LPND），但LPNs可能对新辅助放化疗（nCRT）有反应。我们的目的是确定中低位直肠癌nCRT后LPND的最佳适应证。
在三家三级转诊医院接受治疗的2263例临床II/III期的中低位直肠癌患者中，66例行根治性手术（包括nCRT后行LPND）的患者纳入本研究。回顾性分析LPN转移的危险因素，并根据LPN对nCRT的反应确定肿瘤学结局。
nCRT后磁共振成像上持续存在的大于5mm的LPNs与残留肿瘤转移显著相关，与nCRT后有反应的LPN（短轴直径≤5mm）不同（病理上，分别为61.1%[36例中的22例]和0%[30例中的0例]，P<0.001）。多变量分析显示，nCRT后LPN大小是LPN转移的一个显著且独立的危险因素（比值比2.390；95%置信区间1.104 - 4.069）。中位随访39.3个月，有反应性淋巴结的患者复发率低于有持续性淋巴结的患者（分别为20%[30例中的6例]和47.2%[36例中的17例]，P = 0.012）。有持续性LPN的患者5年总生存率和5年无病生存率低于有反应性LPN的患者（分别为44.6%对77.1%，P = 0.034；33.7%对72.5%，P = 0.011）。
在伴有临床可转移LPNs的中低位直肠癌中，是否进行LPND的决定应基于LPN对nCRT的反应。
