Division of Minimally Invasive Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-chou, Chuo-ku, Kobe, 650-0017, Japan.
Division of International Clinical Cancer Research, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Int J Colorectal Dis. 2018 Apr;33(4):367-374. doi: 10.1007/s00384-018-2974-1. Epub 2018 Feb 13.
The clinical significance of preoperative chemoradiotherapy (CRT) and lateral lymph node dissection (LLND) for locally advanced rectal cancer remains unclear. We have employed total mesorectal excision and selective LLND following preoperative CRT for patients with locally advanced rectal cancer. The validity of our strategy was evaluated.
A total of 45 patients with locally advanced rectal cancer who underwent curative surgery after CRT from November 2005 to September 2016 were retrospectively analyzed. LLND was performed only for the patients with lateral lymph nodes suspected to have metastasis based on the pretreatment images.
Rates of 5-year overall survival (OS) and 5-year relapse-free survival (RFS) were 85.7 and 61.8%, respectively. Univariate and multivariate analyses detected only histological response (grades 2 and 3 vs. grade 1) as a significant prognostic factor for OS and local recurrence. ypN and ypStage were significant factors for RFS by univariate analysis, while no significant factor was detected by multivariate analysis. There was no significant factor for distant recurrence. In good responders (grades 2 and 3), the local recurrence rate was 0% (P = 0.006, vs. grade 1), while distant recurrence developed in 4 of 20 cases (20%, P = 0.615, vs. grade 1). There was no local recurrence in LLND (-) group regardless the histological response.
Although selective LLND with preoperative CRT seems effective and valid for good responders, new treatment strategy is necessary for poor responders. Therefore, development of reliable biomarkers for histological response to CRT is an urgent need.
术前放化疗（CRT）和侧方淋巴结清扫（LLND）对局部进展期直肠癌的临床意义仍不清楚。我们对局部进展期直肠癌患者采用术前 CRT 后全直肠系膜切除术和选择性 LLND。评估了我们策略的有效性。
回顾性分析 2005 年 11 月至 2016 年 9 月期间因 CRT 后接受根治性手术的 45 例局部进展期直肠癌患者。仅对基于预处理图像怀疑有侧方淋巴结转移的患者进行 LLND。
5 年总生存率（OS）和 5 年无复发生存率（RFS）分别为 85.7%和 61.8%。单因素和多因素分析均发现仅组织学反应（2 级和 3 级与 1 级）是 OS 和局部复发的显著预后因素。ypN 和 ypStage 是 RFS 的单因素显著因素，而多因素分析未发现显著因素。无远处复发的显著因素。在良好反应者（2 级和 3 级）中，局部复发率为 0%（P=0.006，与 1 级相比），而远处复发发生在 20 例中的 4 例（20%，P=0.615，与 1 级相比）。无论组织学反应如何，在 LLND（-）组中均未发生局部复发。
尽管术前 CRT 联合选择性 LLND 对良好反应者似乎有效且有效，但对于反应不良者需要新的治疗策略。因此，迫切需要开发用于 CRT 组织学反应的可靠生物标志物。
