Nagasaki Toshiya, Akiyoshi Takashi, Fujimoto Yoshiya, Konishi Tsuyoshi, Nagayama Satoshi, Fukunaga Yosuke, Ueno Masashi
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
World J Surg. 2017 Mar;41(3):876-883. doi: 10.1007/s00268-016-3748-y.
Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced low rectal cancer (LALRC). However, the prognostic significance of CRT in patients with lateral lymph node metastasis (LLNM) is unknown. The present study aimed to examine the prognostic impact of preoperative CRT in patients with LALRC and LLNM.
We retrospectively analyzed data for 73 patients with LALRC and LLNM who underwent total mesorectal excision and lateral lymph node dissection from 1985 to 2012. The patient population was divided into a CRT group (n = 30) who received preoperative CRT and a surgery alone group (n = 43) who were treated without CRT.
The 5-year overall survival (OS), 5-year relapse-free survival (RFS), and 5-year local recurrence (LR) rates were significantly better in the CRT group (78.2, 72.1, and 3.5 %, respectively) compared with the surgery alone group (41.1, 25.4, and 39.6 %, respectively). There were fewer total, mesorectal, and LLNMs in the CRT group compared with the surgery alone group. Multivariate analysis showed that surgery without CRT was an independent predictor of poorer OS (hazard ratio [HR] 3.513, p = 0.004), RFS (HR 2.696, p = 0.021), and LR rates (HR 11.094, p = 0.001). A total number of lymph node metastases ≥4 were also an independent predictor of poorer OS and RFS.
Preoperative CRT might have a significant prognostic impact on patients with LALRC with LLNM treated with total mesorectal excision and lateral lymph node dissection.
术前放化疗（CRT）是局部晚期低位直肠癌（LALRC）的标准治疗方法。然而，CRT对伴有侧方淋巴结转移（LLNM）患者的预后意义尚不清楚。本研究旨在探讨术前CRT对LALRC和LLNM患者的预后影响。
我们回顾性分析了1985年至2012年间73例接受全直肠系膜切除和侧方淋巴结清扫的LALRC和LLNM患者的数据。将患者分为接受术前CRT的CRT组（n = 30）和未接受CRT治疗的单纯手术组（n = 43）。
与单纯手术组（分别为41.1%、25.4%和39.6%）相比，CRT组的5年总生存率（OS）、5年无复发生存率（RFS）和5年局部复发（LR）率明显更好（分别为78.2%、72.1%和3.5%）。与单纯手术组相比，CRT组的总淋巴结、直肠系膜和侧方淋巴结转移较少。多因素分析显示，未接受CRT的手术是OS较差（风险比[HR] 3.513，p = 0.004）、RFS较差（HR 2.696，p = 0.021）和LR率较高（HR 11.094，p = 0.001）的独立预测因素。淋巴结转移总数≥4也是OS和RFS较差的独立预测因素。
术前CRT可能对接受全直肠系膜切除和侧方淋巴结清扫的LALRC伴LLNM患者有显著的预后影响。
