Lee Soo Young, Kim Chang Hyun, Kim Young Jin, Kim Hyeong Rok
Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.
J Surg Oncol. 2018 Mar;117(3):514-522. doi: 10.1002/jso.24871. Epub 2017 Nov 1.
This study aimed to evaluate the prognostic significance of lymph node distribution (LND) in rectal cancer after neoadjuvant chemoradiation.
A total of 519 patients with primary rectal cancer who underwent curative resection after neoadjuvant chemoradiation were included. LND was classified into four groups: LND0, no lymph node metastasis (368/519, 70.9%); LNDp, lymph node metastasis along the inferior mesenteric artery (proximal) (15/519, 2.9%); LNDm, lymph node metastasis at the mesorectum (109/519, 21.0%); and LNDpm, lymph node metastasis at both the proximal and mesorectal areas (27/519, 5.2%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors.
In patients with positive lymph nodes, LND showed superior discrimination for 3-year DFS (LNDp 67.7%, LNDm 48.9%, and LNDpm 26.8%, P = 0.003) and 3-year LRFS (LNDp 93.3%, LNDm 81.4%, and LNDpm 60.5%, P = 0.009) compared to ypN stage (3-year DFS, N1 47.8%, N2 40.0%, P = 0.184; 3-year LRFS, N1 79.4%, N2 75.2%, P = 0.527). On multivariate survival analysis, LND was an independent prognostic factor for LRFS (P = 0.030) in patients with positive lymph nodes.
LND may improve the prognostic value of the ypTNM staging system for patients with node-positive rectal cancer after neoadjuvant chemoradiation, particularly in terms of local recurrence.
本研究旨在评估新辅助放化疗后直肠癌患者淋巴结分布（LND）的预后意义。
纳入519例新辅助放化疗后接受根治性切除的原发性直肠癌患者。LND分为四组：LND0，无淋巴结转移（368/519，70.9%）；LNDp，沿肠系膜下动脉（近端）有淋巴结转移（15/519，2.9%）；LNDm，直肠系膜有淋巴结转移（109/519，21.0%）；LNDpm，近端和直肠系膜区域均有淋巴结转移（27/519，5.2%）。分析临床病理特征以确定独立预后因素。
在淋巴结阳性患者中，与ypN分期相比，LND对3年无病生存率（LNDp为67.7%，LNDm为48.9%，LNDpm为26.8%，P = 0.003）和3年局部复发无病生存率（LNDp为93.3%，LNDm为81.4%，LNDpm为60.5%，P = 0.009）显示出更好的区分度（3年无病生存率，N1为47.8%，N2为40.0%，P = 0.184；3年局部复发无病生存率，N1为79.4%，N2为75.2%，P = 0.527）。多因素生存分析显示，LND是淋巴结阳性患者局部复发无病生存率的独立预后因素（P = 0.030）。
LND可能提高新辅助放化疗后淋巴结阳性直肠癌患者ypTNM分期系统的预后价值，尤其是在局部复发方面。
