Baucom Rebeccah B, Maguire Lillias H, Kavalukas Sandra L, Geiger Timothy M, Ford Molly M, Muldoon Roberta L, Hopkins M Benjamin, Hawkins Alexander T
1 Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 2 Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, Minnesota.
Dis Colon Rectum. 2017 Dec;60(12):1260-1266. doi: 10.1097/DCR.0000000000000947.
A subset of patients with rectal cancer who undergo neoadjuvant chemoradiation therapy will develop a complete pathologic tumor response. Complete nodal response is not universal in these patients and is difficult to assess clinically. Quantifying the risk of nodal disease would allow for targeted therapy with either radical resection or "watchful waiting."
This study aimed to identify risk factors for residual nodal disease in ypT0 rectal adenocarcinoma.
This is a retrospective case control study.
The National Cancer Database 2006 to 2014 was used to identify patients for this study.
Patients with stage II/III rectal adenocarcinoma who completed chemoradiation therapy followed by resection and who had ypT0 tumors were included. Patients with metastatic disease and <2 lymph nodes evaluated were excluded. Patients were divided into 2 groups: node positive and node negative.
The main outcome was nodal disease. The secondary outcome was overall survival.
A total of 42,257 patients with stage II/III rectal cancer underwent chemoradiation therapy and radical resection; 4170 (9.9%) patients had ypT0 tumors and 395 (9.5%) were node positive. Of patients with clinically node-negative disease (ie, pretreatment imaging), 6.2% were node positive after chemoradiation therapy and resection. In multivariable analysis, factors predictive of nodal disease included increasing (pretreatment) clinical N-stage, high tumor grade (3/4), perineural invasion, and lymphovascular invasion. Higher clinical T-stage was inversely associated with residual nodal disease. Overall 5-year survival was significantly different between patients with ypN0, ypN1, and ypN2 disease (87.4%, 82.2%, and 62.5%, p = 0.002).
This study was limited by the lack of clinical detail in the database and the inability to assess recurrence.
Ten percent of patients with ypT0 tumors had positive nodes after chemoradiation therapy and resection. Factors associated with residual nodal disease included clinical nodal disease at diagnosis and poor histologic features. Patients with any of these features should consider radical resection regardless of tumor response. Others could be suitable for "watchful waiting" strategies. See Video Abstract at http://links.lww.com/DCR/A458.
接受新辅助放化疗的直肠癌患者中有一部分会出现完全病理肿瘤反应。完全淋巴结反应在这些患者中并不普遍，且临床上难以评估。量化淋巴结疾病风险将有助于采取根治性切除或“观察等待”的靶向治疗。
本研究旨在确定ypT0直肠腺癌残留淋巴结疾病的危险因素。
这是一项回顾性病例对照研究。
使用2006年至2014年的国家癌症数据库来确定本研究的患者。
纳入完成放化疗后行手术切除且ypT0肿瘤的II/III期直肠腺癌患者。排除有转移性疾病和评估淋巴结<2枚的患者。患者分为两组：淋巴结阳性组和淋巴结阴性组。
主要观察指标为淋巴结疾病。次要观察指标为总生存期。
共有42257例II/III期直肠癌患者接受了放化疗和根治性切除；4170例（9.9%）患者为ypT0肿瘤，395例（9.5%）淋巴结阳性。在临床淋巴结阴性疾病（即治疗前影像学检查）患者中，6.2%在放化疗和切除后淋巴结阳性。多变量分析中，淋巴结疾病的预测因素包括（治疗前）临床N分期增加、肿瘤高分级（3/4级）、神经周围侵犯和脉管侵犯。较高的临床T分期与残留淋巴结疾病呈负相关。ypN0、ypN1和ypN2疾病患者的5年总生存期有显著差异（87.4%、82.2%和62.5%，p = 0.002）。
本研究受数据库中临床细节缺乏及无法评估复发的限制。
10%的ypT0肿瘤患者在放化疗和切除后淋巴结阳性。与残留淋巴结疾病相关的因素包括诊断时的临床淋巴结疾病和不良组织学特征。有这些特征的患者无论肿瘤反应如何都应考虑根治性切除。其他患者可能适合“观察等待”策略。见视频摘要：http://links.lww.com/DCR/A458 。
