Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
Int J Colorectal Dis. 2019 Jun;34(6):1121-1129. doi: 10.1007/s00384-019-03294-2. Epub 2019 May 1.
Para-aortic lymph node (PALN) metastasis of colorectal cancer is rare, and the treatment strategy for PALN metastasis (PALNM) is not established in contrast to liver or lung metastases. We sought to evaluate the survival outcomes and prognostic factors among patients undergoing surgery combined with extended lymphadenectomy for PALNM from left-sided colorectal cancer.
From 1992 to 2012, 322 patients who underwent PALN dissection (PALND) synchronously with primary resection, among 1819 left-sided colorectal surgical cases, were retrospectively examined. We investigated the overall survival (OS) and prognostic factors for patients with PALNM.
Of the 322 patients, 62 (19.3%) were histologically confirmed to have PALNM. The 5-year OS in patients with and without PALNM was 19.5% and 67.0% (p < 0.001), respectively. Among patients with PALNM, on the multivariable analysis, the positive resection margin (hazard ratio (HR) 3.61; 95% confidence interval (CI) 1.85-7.06), undifferentiated histological type ((por/muc/sig), HR 4.51; 95% CI, 2.22-9.19), ≥ 4 PALNMs (HR 3.34; 95% CI 1.53-7.31), and preoperative CEA ≥ 10 ng/mL (HR 2.1; 95% CI 1.11-4.27) were significant prognostic factors. Among R0 resected cases, the 5-year OS of the 17 cases with ≤ 3 PALNM and well/moderately differentiated adenocarcinoma was 54.2%, which was comparable to that of patients undergoing PALND and diagnosed with stage IIIC (49.6%).
Patients with PALNM of colorectal cancer had a poor prognosis. However, curative resection, ≤ 3 PALNM, and well/moderately differentiated histology type were associated with the long-term survival.
结直肠癌的腹主动脉旁淋巴结（PALN）转移较为罕见，与肝或肺转移不同，PALN 转移（PALNM）的治疗策略尚未建立。我们旨在评估左侧结直肠癌患者行 PALNM 手术联合扩大淋巴结清扫术的生存结局和预后因素。
1992 年至 2012 年，对 1819 例左侧结直肠手术病例中同步行 PALN 解剖（PALND）的 322 例患者进行回顾性检查。我们研究了 PALNM 患者的总生存率（OS）和预后因素。
322 例患者中，62 例（19.3%）经组织学证实存在 PALNM。有和无 PALNM 的患者 5 年 OS 分别为 19.5%和 67.0%（p<0.001）。在有 PALNM 的患者中，多变量分析显示，阳性切缘（危险比（HR）3.61；95%置信区间（CI）1.85-7.06）、未分化组织学类型（por/muc/sig，HR 4.51；95%CI，2.22-9.19）、≥4 个 PALNMs（HR 3.34；95%CI，1.53-7.31）和术前 CEA≥10ng/mL（HR 2.1；95%CI，1.11-4.27）是显著的预后因素。在 RO 切除病例中，17 例≤3 个 PALNM 和高/中分化腺癌的 5 年 OS 为 54.2%，与行 PALND 诊断为 IIIC 期的患者（49.6%）相当。
结直肠癌 PALNM 患者预后较差。然而，根治性切除、≤3 个 PALNM 和高/中分化组织学类型与长期生存相关。
