根治性放疗后的直肠癌：在新辅助治疗时代，真的需要 12 个淋巴结吗？
Resected irradiated rectal cancers: Are twelve lymph nodes really necessary in the era of neoadjuvant therapy?
机构信息
Department of General Surgery, Duke University Medical Center, Durham, NC, United States.
Department of General Surgery, Duke University Medical Center, Durham, NC, United States.
出版信息
Am J Surg. 2018 Sep;216(3):444-449. doi: 10.1016/j.amjsurg.2017.08.014. Epub 2017 Aug 26.
BACKGROUND
Our study aims to identify the minimum number of lymph nodes (LN) associated with improved survival in patients who underwent NRT for stage II-III rectal cancer.
METHODS
Adults with clinical stage II and III rectal adenocarcinoma in the National Cancer Data Base were stratified by NRT. Multivariable Cox regression modeling with restricted cubic splines was used to determine the minimum number of LNs associated with improved survival.
RESULTS
Of 38,363 patients, 76% received NRT. After adjustment, a LNY≥12 was associated with improved survival among patients receiving NRT (HR 0.79, p < 0.0001) and those without NRT (HR 0.88, p = 0.04). Among patients receiving NRT, factors independently associated with LNY≥12 were younger age, private insurance, low comorbidity score, a recent year of diagnosis, higher T stage and grade, APR resection, and academic institution.
CONCLUSIONS
A minimum LNY of 12 confers a survival benefit for rectal cancer patients regardless of receiving neoadjuvant radiation therapy.
背景
本研究旨在确定接受 II-III 期直肠癌新辅助放疗（NRT）的患者中与生存改善相关的最小淋巴结数量。
方法
国家癌症数据库中对临床 II 期和 III 期直肠腺癌患者进行 NRT 分层。采用受限立方样条的多变量 Cox 回归模型确定与生存改善相关的最小淋巴结数量。
结果
在 38363 名患者中，76%接受了 NRT。调整后，NRT 组和未接受 NRT 组的 LNY≥12 与生存改善相关（HR 0.79，p<0.0001；HR 0.88，p=0.04）。在接受 NRT 的患者中，与 LNY≥12 独立相关的因素包括年龄较小、私人保险、低合并症评分、最近诊断年份、较高的 T 分期和分级、腹会阴联合切除术和学术机构。
结论
无论是否接受新辅助放疗，最低 LNY 为 12 个可使直肠癌患者获益。
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