Lu Zhao, Cheng Pu, Yang Fu, Zheng Zhaoxu, Wang Xishan
Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Chin J Cancer Res. 2018 Apr;30(2):272-281. doi: 10.21147/j.issn.1000-9604.2018.02.10.
For patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy (NCRT), significant pathological response of the primary tumor has been proposed to identify candidates for organ preservation. However, this does not address metastatic lymph nodes in the mesorectum. The aim of this study was to assess the incidence of lymph node metastases in ypT0 patients treated with NCRT and curative resection and to explore risk factors associated with survival.
This was a retrospective study of patients with ypT0 rectal cancer after NCRT and curative resection at a tertiary care center in China from 2005 to 2014.
A total of 60 (18.6%) patients who underwent surgery after NCRT and achieved ypT0 were enrolled in this study; one patient was excluded owing to lack of follow-up. Of these 59 patients, lymph node metastases were found in the mesorectum (ypT0N+) in eight (13.6%) patients. After a median follow-up of 52 months, 5-year recurrence-free survival (82.7% 62.5%, P=0.014) and overall survival (OS) (90.9% 70.0%, P=0.032) were much higher in ypN0 than ypN+ patients. Multivariate analyses showed that ypN+ status (P=0.009) and perioperative blood transfusion (BT) (P=0.001) were significantly independent risk factors associated with recurrence; however, no factor was correlated with 5-year OS.
Patients with ypT0N0 rectal cancer can achieve excellent long-term outcomes; however, positive lymph nodes or tumor deposits can still be found in 13.6% of ypT0 patients. Nodal positivity in the mesorectum and perioperative BT are independent risk factors for recurrence.
对于接受新辅助放化疗（NCRT）治疗的局部晚期直肠癌患者，已提出原发性肿瘤的显著病理反应可用于识别器官保留的候选者。然而，这并未涉及直肠系膜中的转移性淋巴结。本研究的目的是评估接受NCRT和根治性切除的ypT0患者中淋巴结转移的发生率，并探索与生存相关的危险因素。
这是一项对2005年至2014年在中国一家三级医疗中心接受NCRT和根治性切除术后的ypT0直肠癌患者的回顾性研究。
共有60例（18.6%）接受NCRT后手术并达到ypT0的患者纳入本研究；1例患者因缺乏随访而被排除。在这59例患者中，8例（13.6%）患者的直肠系膜中发现有淋巴结转移（ypT0N+）。中位随访52个月后，ypN0患者的5年无复发生存率（82.7%对62.5%，P=0.014）和总生存率（OS）（90.9%对70.0%，P=0.032）远高于ypN+患者。多因素分析显示，ypN+状态（P=0.009）和围手术期输血（BT）（P=0.001）是与复发显著相关的独立危险因素；然而，没有因素与5年OS相关。
ypT0N0直肠癌患者可获得优异的长期预后；然而，仍有13.6%的ypT0患者可发现阳性淋巴结或肿瘤沉积物。直肠系膜淋巴结阳性和围手术期BT是复发的独立危险因素。
