Bustamante-Lopez L, Nahas C S, Nahas S C, Ribeiro U, Marques C F, Cotti G, Rocco A, Cecconello I
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - Instituto de Câncer do Estado de Sáo Paulo, Sao Paulo, Brazil.
Int J Colorectal Dis. 2017 Jun;32(6):925-927. doi: 10.1007/s00384-016-2747-7. Epub 2016 Dec 29.
Rectal cancer patients frequently present with locally advanced disease for which the standard of care includes neoadjuvant chemoradiotherapy followed by total mesorectal excision. Positive lymph nodes are one of the most powerful risk factors for recurrence and survival in colorectal cancer. In the absence of specific rectal guidelines, the literature recommends to the pathologist to optimize the number of rectal lymph nodes (LN) retrieved. We made a literature review in order to identify factors that could potentially affect the number of LN retrieved in specimens of patients with rectal cancer treated by chemoradiotherapy (CRT) followed by total mesorectal excision (TME).
Age did not have a significant effect on LN yield. The effect of sex on LN number is not consistent in the literature. Most of the papers did not find a relationship between lower LN obtained and gender. Laparoscopy for primary rectal cancer is associated with a greater number of LN as well as short-term benefits. Tumors in the upper rectum are associated with a higher number of LN than those in the mid and lower rectum. The type of surgery had no effect on lymph node yield either. Tumors with complete or almost complete pathologic regression were exactly the ones with lower number of lymph nodes detected. Approximately one-third of patients with neoadjuvant treatment had less than 12 LN yield.
The tumor regression grade is the most important factor for the decrease in the number of lymph nodes.
直肠癌患者常表现为局部晚期疾病，其标准治疗方案包括新辅助放化疗，随后进行全直肠系膜切除术。阳性淋巴结是结直肠癌复发和生存的最强危险因素之一。在缺乏特定直肠指南的情况下，文献建议病理学家优化直肠癌切除标本中获取的淋巴结数量。我们进行了一项文献综述，以确定可能影响接受放化疗（CRT）后行全直肠系膜切除术（TME）的直肠癌患者标本中获取的淋巴结数量的因素。
年龄对淋巴结获取量无显著影响。性别对淋巴结数量的影响在文献中并不一致。大多数论文未发现获取的低位淋巴结与性别之间存在关联。原发性直肠癌腹腔镜手术与更多的淋巴结数量以及短期获益相关。上段直肠癌比中下段直肠癌的淋巴结数量更多。手术方式对淋巴结获取量也无影响。病理完全或几乎完全消退的肿瘤，其检测到的淋巴结数量恰好较少。约三分之一接受新辅助治疗的患者淋巴结获取量少于12个。
肿瘤消退分级是淋巴结数量减少的最重要因素。
