Ishihara Soichiro, Kawai Kazushige, Tanaka Toshiaki, Kiyomatsu Tomomichi, Hata Keisuke, Nozawa Hioaki, Morikawa Teppei, Watanabe Toshiaki
1 Department of Surgical Oncology, University of Tokyo, Tokyo, Japan 2 Department of Pathology, University of Tokyo Hospital, Tokyo, Japan.
Dis Colon Rectum. 2017 May;60(5):469-476. doi: 10.1097/DCR.0000000000000752.
BACKGROUND: Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy remain to be elucidated. OBJECTIVE: The purpose of this study was to clarify the therapeutic effect of chemoradiotherapy on lateral pelvic lymph node metastasis, the risk factors of lateral pelvic lymph node metastasis, and oncological outcomes of lateral pelvic lymph node dissection after chemoradiotherapy. DESIGN: This was a nonrandomized, retrospective study. SETTINGS: The study was conducted at a tertiary referral university hospital. PATIENTS: Patients with rectal cancer treated with chemoradiotherapy and radical surgery from 2003 to 2015 (N = 222) were included. INTERVENTIONS: Radiation (total, 50.4 Gy in 28 fractions) with concomitant fluorouracil-based chemotherapy was administered. Lateral pelvic lymph nodes with a diameter of ≥8 mm before chemoradiotherapy were selectively dissected. MAIN OUTCOME MEASURES: Frequency and risk factors of lateral pelvic lymph node metastasis were examined. RESULTS: Lateral pelvic lymph node dissection was performed in 31 patients (14.0%), and 16 (51.6%) of these patients were pathologically diagnosed as positive for metastasis. Among the patients treated with total mesorectal excision alone (n = 191), 2 (0.9%) had recurrence in the lateral pelvic lymph node area, which was pathologically confirmed after salvage R0 resection. T category downstaging (73.3% vs 12.5%; p < 0.01) and high histological regression of the primary lesion (73.3% vs 18.8%; p < 0.01) were more frequent in patients with pathologically negative lateral pelvic lymph nodes than in those with positive lateral pelvic lymph nodes. Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were associated with lateral pelvic lymph node metastasis. LIMITATIONS: The study was limited by its retrospective nature and small study population. CONCLUSIONS: The incidence of lateral pelvic lymph node metastasis after chemoradiotherapy was estimated to be 8.1% (18/222). Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were risk factors of lateral pelvic lymph node metastasis after chemoradiotherapy.
背景：术前放化疗治疗直肠癌时，盆腔外侧淋巴结转移的肿瘤学结局仍有待阐明。 目的：本研究旨在明确放化疗对盆腔外侧淋巴结转移的治疗效果、盆腔外侧淋巴结转移的危险因素以及放化疗后盆腔外侧淋巴结清扫的肿瘤学结局。 设计：这是一项非随机回顾性研究。 地点：研究在一家三级转诊大学医院进行。 患者：纳入2003年至2015年接受放化疗及根治性手术的直肠癌患者（N = 222）。 干预措施：给予放疗（总量50.4 Gy，分28次）并联合氟尿嘧啶类化疗。对放化疗前直径≥8 mm的盆腔外侧淋巴结进行选择性清扫。 主要观察指标：检查盆腔外侧淋巴结转移的频率及危险因素。 结果：31例患者（14.0%）接受了盆腔外侧淋巴结清扫，其中16例（51.6%）经病理诊断为转移阳性。在仅接受全直肠系膜切除术的患者（n = 191）中，2例（0.9%）出现盆腔外侧淋巴结区域复发，挽救性R0切除术后经病理证实。盆腔外侧淋巴结病理阴性的患者比阳性患者更常出现T分期降期（73.3%对12.5%；p < 0.01）和原发灶的高组织学消退（73.3%对18.8%；p < 0.01）。年轻、距肛缘距离短以及放化疗前盆腔外侧淋巴结肿大与盆腔外侧淋巴结转移相关。 局限性：本研究受其回顾性性质和小样本研究人群的限制。 结论：放化疗后盆腔外侧淋巴结转移的发生率估计为8.1%（18/222）。年轻、距肛缘距离短以及放化疗前盆腔外侧淋巴结肿大是放化疗后盆腔外侧淋巴结转移的危险因素。
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