Kim Hye Jin, Choi Gyu-Seog, Park Jun Seok, Park Soo Yeun, Cho Seung Hyun, Lee Soo Jung, Kang Byung Woog, Kim Jong Gwang
Colorectal Cancer Center, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Radiology, Kyungpook National University Medical Center, School of Medicine, Kyungpook National University, Daegu, Korea.
Oncotarget. 2017 Aug 10;8(59):100724-100733. doi: 10.18632/oncotarget.20121. eCollection 2017 Nov 21.
Although lateral pelvic lymph node (LPN) metastasis is a major cause of local recurrence in patients with rectal cancer, controversy still remains on the treatment of suspected LPN metastasis, "suspicious LPN". We aimed to determine the optimal treatment strategies for suspicious LPN, in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy (CRT).
Of 377 patients who received preoperative CRT for rectal cancer between 2006 and 2013, 84 (22.3%) had suspicious LPNs on pretreatment MRI. Patients' characteristics, MRI findings, operative and pathologic findings, and oncologic outcomes were analyzed retrospectively.
Of 84 patients with suspicious LPNs, 61 showed good response to CRT on posttreatment MRI (short-axis LPN diameter < 5 mm). Among them, 31 patients underwent TME alone (group A), and 30 underwent TME plus LPND (group B). The remaining 23 patients had persistently suspicious LPNs on post-CRT MRI and underwent TME plus LPND (group C). Pathologic LPN metastasis was confirmed in five patients (16.7%) in group B and 15 (62.5%) in group C. Local recurrence developed in 7 (22.6%), 0 (0%), and 4 (17.4%) patients in groups A, B, and C, respectively. Five patients (16.1%) in group A developed LPN recurrences. The 3-year disease-free survival rates were 53.7%, 74.2%, and 46.9% in groups A, B, and C, respectively.
Study findings suggested that LPND cannot be omitted for patients with suspicious LPNs on pretreatment MRI even with good response to CRT. Findings from pretreatment MRI should be considered to determine whether LPND is indicated.
尽管侧方盆腔淋巴结（LPN）转移是直肠癌患者局部复发的主要原因，但对于可疑LPN转移（“可疑LPN”）的治疗仍存在争议。我们旨在确定接受术前放化疗（CRT）的局部晚期直肠癌患者可疑LPN的最佳治疗策略。
在2006年至2013年间接受直肠癌术前CRT的377例患者中，84例（22.3%）在治疗前MRI上有可疑LPN。回顾性分析患者的特征、MRI表现、手术和病理结果以及肿瘤学结局。
84例有可疑LPN的患者中，61例在治疗后MRI上显示对CRT反应良好（LPN短轴直径<5mm）。其中，31例患者仅接受了全直肠系膜切除术（A组），30例接受了全直肠系膜切除术加LPN清扫术（B组）。其余23例患者在CRT后MRI上仍有可疑LPN，并接受了全直肠系膜切除术加LPN清扫术（C组）。B组有5例患者（16.7%）病理证实有LPN转移，C组有15例（62.5%）。A、B、C组分别有7例（22.6%）、0例（0%）和4例（17.4%）患者发生局部复发。A组有5例患者（16.1%）发生LPN复发。A、B、C组的3年无病生存率分别为53.7%、74.2%和46.9%。
研究结果表明，即使对CRT反应良好，对于治疗前MRI上有可疑LPN的患者，LPN清扫术也不能省略。应考虑治疗前MRI的结果来确定是否需要进行LPN清扫术。
