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新辅助放化疗后直肠癌标本淋巴结检出量:两种固定剂的随机对照研究。

Lymph Node Yield After Neoadjuvant Chemoradiotherapy in Rectal Cancer Specimens: A Randomized Trial Comparing Two Fixatives.

机构信息

Department of Gastroenterology, Hospital das Clinicas, Cancer Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil.

出版信息

Dis Colon Rectum. 2018 Aug;61(8):888-896. doi: 10.1097/DCR.0000000000001097.

Abstract

BACKGROUND

It is widely reported that neoadjuvant chemoradiation reduces lymph node yield in rectal cancer specimens. Some have questioned the adequacy of finding ≥12 lymph nodes for accurate staging, and fewer nodes were correlated with good response. Others reported that low lymph node count raises the chance for understaging and correlates with worse survival. In addition, a few studies demonstrated that diligent specimen analysis increases lymph node count.

OBJECTIVE

The aim of this study was to compare Carnoy's solution and formalin concerning lymph node yield in specimens of patients with rectal cancer after neoadjuvant chemoradiation.

DESIGN

This is a prospective randomized trial that was conducted from 2012 to 2015.

SETTINGS

This study was performed in a reference cancer center in Brazil.

PATIENTS

Patients who underwent low anterior resection with total mesorectal excision after neoadjuvant chemoradiation for rectal adenocarcinoma were included.

INTERVENTION

Rectosigmoid specimens were randomized for fixation with Carnoy's solution or formalin.

MAIN OUTCOME MEASURES

A total of 130 specimens were randomized. After dissection, the residual fat from the formalin group was immersed in Carnoy's solution in search for missed lymph nodes (Revision).

RESULTS

The Carnoy's solution group had superior lymph node count (24.0 vs 16.3, p < 0.01) and fewer cases with <12 lymph nodes (6 vs 22, p = 0.001). The Revision group found lymph nodes in all cases (mean, 11.1), retrieving metastatic lymph nodes in 6 patients. It reduced the formalin cases with <12 lymph nodes from 33.8% to 4.6% and upstaged 2 patients. Tumor response to neoadjuvant chemoradiotherapy was not associated with lymph node count.

LIMITATIONS

This was a unicentric study.

CONCLUSIONS

Compared with formalin, the Carnoy's solution increases lymph node count and reduces the cases with <12 lymph nodes. Harvested lymph nodes are missed following routine analysis and this is clinically relevant. Finding <12 lymph nodes is not a sign of good response to neoadjuvant chemoradiation (www.clinicaltrials.gov. Unique identifier: NCT02629315). See Video Abstract at http://links.lww.com/DCR/A694.

摘要

背景

有报道称新辅助放化疗会降低直肠癌标本中的淋巴结检出数量。有人质疑 12 枚以上淋巴结的检出数量是否足以进行准确分期,而且较少的淋巴结与较好的治疗反应相关。其他人则报告称,低淋巴结计数会增加分期不足的可能性,并与更差的生存相关。此外,一些研究表明,通过仔细分析标本可以增加淋巴结的检出数量。

目的

本研究旨在比较新辅助放化疗后直肠癌患者标本中 Carnoy 液和福尔马林固定液对淋巴结检出数量的影响。

设计

这是一项前瞻性随机试验,于 2012 年至 2015 年进行。

地点

该研究在巴西的一家癌症参考中心进行。

患者

纳入接受新辅助放化疗后行低位前切除术+全直肠系膜切除术的直肠腺癌患者。

干预

直肠乙状结肠标本随机分为 Carnoy 液固定组和福尔马林固定组。

主要观察指标

共 130 例标本进行了随机分组。福尔马林组标本在解剖完成后,将剩余的脂肪浸泡在 Carnoy 液中以寻找遗漏的淋巴结(复习)。

结果

Carnoy 液组的淋巴结检出数量更高(24.0 枚比 16.3 枚,p < 0.01),且<12 枚淋巴结的病例更少(6 例比 22 例,p = 0.001)。复习组在所有病例中均发现了淋巴结(平均 11.1 枚),并在 6 例患者中发现了转移性淋巴结。该方法将福尔马林组<12 枚淋巴结的病例数从 33.8%减少到 4.6%,并将 2 例患者的分期提高。新辅助放化疗的肿瘤反应与淋巴结计数无关。

局限性

这是一项单中心研究。

结论

与福尔马林相比,Carnoy 液增加了淋巴结的检出数量,减少了<12 枚淋巴结的病例数。常规分析后会遗漏部分淋巴结,这具有重要的临床意义。检出<12 枚淋巴结并不表示对新辅助放化疗有较好的反应(www.clinicaltrials.gov,注册号:NCT02629315)。欲观看视频摘要,请访问 http://links.lww.com/DCR/A694。

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