Mirbagheri N, Kumar B, Deb S, Poh B R, Dark J G, Leow C C, Teoh W M K
Department of Academic Surgery, Dandenong Hospital, Melbourne, Victoria, Australia.
Colorectal Dis. 2014 Oct;16(10):O339-46. doi: 10.1111/codi.12682.
The primary aim of this study was to examine lymph node status after neoadjuvant chemoradiotherapy (CRT) using a novel scoring system describing the pathological lymph node regression grade. The proposed scoring system was based on the percentage of fibrosis and the presence of residual tumour amount. The secondary aim of the study was to assess the oncological impact of this scoring system.
The project was a retrospective cohort study over a 10-year period. Two hundred and two patients with rectal cancer who had received CRT followed by curative surgery were included. A histopathologist prospectively scored each specimen and the impact of the scoring system on survival and recurrence was analysed.
One hundred and ninety patients completed long-course preoperative CRT and formed the basis of the study. Overall, 40 recurrences (local and distant) were observed over a median follow-up of 36 months. The lymph node regression score was a significant predictor of tumour recurrence (hazard ratio 1.273, 95% CI 1.048-1.548; P = 0.015). The overall mortality rate was 21%, and a lower lymph node regression score was correlated with an improved survival curve (P = 0.01).
The results demonstrate that lymph node response to neoadjuvant CRT based on a nodal regression scoring system is related to recurrence.
本研究的主要目的是使用一种描述病理淋巴结消退分级的新型评分系统，来检查新辅助放化疗（CRT）后的淋巴结状态。所提出的评分系统基于纤维化百分比和残留肿瘤量。本研究的次要目的是评估该评分系统对肿瘤学的影响。
该项目是一项为期10年的回顾性队列研究。纳入了202例接受CRT后行根治性手术的直肠癌患者。一名组织病理学家对每个标本进行前瞻性评分，并分析评分系统对生存和复发的影响。
190例患者完成了长程术前CRT并构成了研究基础。总体而言，在中位随访36个月期间观察到40例复发（局部和远处）。淋巴结消退评分是肿瘤复发的显著预测因素（风险比1.273，95%置信区间1.048 - 1.548；P = 0.015）。总死亡率为21%，较低的淋巴结消退评分与改善的生存曲线相关（P = 0.01）。
结果表明，基于淋巴结消退评分系统的新辅助CRT的淋巴结反应与复发有关。
