Ishihara Soichiro, Kawai Kazushige, Tanaka Toshiaki, Hata Keisuke, Nozawa Hiroaki
Department of Digestive Surgery, Sanno Hospital, International University of Health and Welfare, Tokyo, Japan.
Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan.
ANZ J Surg. 2018 Dec;88(12):1306-1310. doi: 10.1111/ans.14717. Epub 2018 Jul 5.
Lateral pelvic lymph node (LLN) dissection is suggested to improve the prognosis of rectal cancer patients; however, accurate diagnosis of LLN metastasis is challenging, especially after preoperative chemoradiotherapy (CRT). The aim of this study was to clarify the diagnostic value of LLN size in rectal cancer patients treated with CRT in terms of metastasis.
A total of 204 LLNs dissected from 29 rectal cancer patients treated with CRT were examined. The correlation between the resected LLN size (long and short axes) and patients' metastasis status was examined.
The long axes of metastatic LLNs were significantly longer than those of non-metastatic LLNs (11.0 ± 5.3 versus 4.4 ± 2.8 mm, respectively; P < 0.0001) as were the short axes (8.1 ± 4.5 versus 2.3 ± 1.2 mm, respectively; P < 0.0001). Receiver operating characteristic analyses of the long and short axes indicated optimal cut-off values of 7 and 4 mm for the prediction of pathological LLN metastasis; the area under the curve values were 0.89 and 0.96, respectively. The accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the long axis for the prediction of pathological metastasis were 82.4, 88.2, 82.2, 48.4 and 97.2%, respectively; those of the short axis were 91.7, 94.1, 87.1, 59.3 and 98.7%, respectively.
The sizes of LLNs significantly correlated with patients' pathological statuses, and their accuracies for the prediction of pathological metastases were high. However, in contrast to the very high NPVs, the PPVs were low (approximately 50%).
盆腔外侧淋巴结（LLN）清扫术被认为可改善直肠癌患者的预后；然而，准确诊断LLN转移具有挑战性，尤其是在术前放化疗（CRT）之后。本研究的目的是阐明在接受CRT治疗的直肠癌患者中，LLN大小对转移的诊断价值。
对29例接受CRT治疗的直肠癌患者所切除的204个LLN进行检查。研究切除的LLN大小（长轴和短轴）与患者转移状态之间的相关性。
转移的LLN的长轴明显长于未转移的LLN（分别为11.0±5.3对4.4±2.8毫米；P<0.0001），短轴也是如此（分别为8.1±4.5对2.3±1.2毫米；P<0.0001）。长轴和短轴的受试者工作特征分析表明，预测病理性LLN转移的最佳截断值分别为7毫米和4毫米；曲线下面积值分别为0.89和0.96。长轴预测病理性转移的准确性、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为82.4%、88.2%、82.2%、48.4%和97.2%；短轴的相应值分别为91.7%、94.1%、87.1%、59.3%和98.7%。
LLN的大小与患者的病理状态显著相关，且其预测病理性转移的准确性较高。然而，与非常高的NPV相比，PPV较低（约50%）。
