基于磁共振成像的术前放化疗前后晚期低位直肠癌患者盆腔侧方淋巴结清扫的指征
Indications for Lateral Pelvic Lymph Node Dissection Based on Magnetic Resonance Imaging Before and After Preoperative Chemoradiotherapy in Patients with Advanced Low-Rectal Cancer.
作者信息
Akiyoshi Takashi, Matsueda Kiyoshi, Hiratsuka Makiko, Unno Toshiyuki, Nagata Jun, Nagasaki Toshiya, Konishi Tsuyoshi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Ueno Masashi
机构信息
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Diagnostic Imaging, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
出版信息
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S614-20. doi: 10.1245/s10434-015-4565-5. Epub 2015 Apr 21.
BACKGROUND
We assessed the magnetic resonance imaging (MRI) findings of lateral pelvic lymph node (LPLN) metastasis in patients with advanced low-rectal cancer treated with preoperative chemoradiotherapy (CRT) and LPLN dissection (LPLD) for clinically suspected LPLN metastasis. Our aim was to identify the optimal indications for LPLD.
METHODS
The study population consisted of 77 patients with advanced low-rectal cancer who underwent LPLD for clinically suspicious LPLN metastasis after preoperative CRT. MRI findings before/after CRT, clinical factors, and LPLN metastasis were evaluated.
RESULTS
LPLN metastasis was confirmed in 31 patients (40.3 %). Metastasis was significantly higher in patients with LPLNs with a short-axis diameter ≥8 mm than in patients with LPLNs with a short-axis diameter <8 mm before CRT (75 vs. 20 %, P < 0.0001). LPLN metastasis was also significantly higher in patients with LPLNs with a short-axis diameter >5 mm than in patients with LPLNs with a short-axis diameter ≤5 mm after CRT (75 vs. 20 %, P < 0.0001). Multivariate analysis showed the independent association of female sex [P = 0.0192; odds ratio (OR) 5.616; 95 % confidence interval (CI) 1.315-28.942], pre-CRT short-axis diameter of the LPLN ≥8 mm (P = 0.0047; OR 9.188; 95 % CI 1.948-54.366), and CRT without induction systemic chemotherapy (P = 0.0285; OR 9.235; 95 % CI 1.241-106.947) with LPLN metastasis.
CONCLUSIONS
MRI before CRT is useful to predict LPLN metastasis and to determine the indications for LPLD.
背景
我们评估了术前接受放化疗（CRT）以及因临床怀疑侧盆腔淋巴结（LPLN）转移而接受LPLN清扫术（LPLD）的晚期低位直肠癌患者的LPLN转移的磁共振成像（MRI）表现。我们的目的是确定LPLD的最佳适应证。
方法
研究人群包括77例晚期低位直肠癌患者，这些患者在术前CRT后因临床怀疑LPLN转移而接受了LPLD。评估了CRT前后的MRI表现、临床因素和LPLN转移情况。
结果
31例患者（40.3%）确诊有LPLN转移。CRT前短轴直径≥8 mm的LPLN患者的转移率显著高于短轴直径<8 mm的LPLN患者（75%对20%，P<0.0001）。CRT后短轴直径>5 mm的LPLN患者的LPLN转移率也显著高于短轴直径≤5 mm的LPLN患者（75%对20%，P<0.0001）。多因素分析显示，女性（P=0.0192；比值比[OR]5.616；95%置信区间[CI]1.315 - 28.942）、CRT前LPLN短轴直径≥8 mm（P=0.0047；OR 9.188；95%CI 1.948 - 54.366）以及未进行诱导全身化疗的CRT（P=0.0285；OR 9.235；95%CI 1.241 - 106.947）与LPLN转移独立相关。
结论
CRT前的MRI有助于预测LPLN转移并确定LPLD的适应证。
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