新辅助放化疗后局部晚期直肠癌患者转移性淋巴结退缩分级的预后价值。
Prognostic value of metastatic lymph node regression grade after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer.
机构信息
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
出版信息
Surgery. 2019 Dec;166(6):1061-1067. doi: 10.1016/j.surg.2019.06.009. Epub 2019 Jul 23.
BACKGROUND
The prognostic value of classifying the degree of metastatic lymph node regression grade after neoadjuvant chemoradiotherapy remains unclear. The aim was to assess the prognostic value of lymph node regression grade in patients with rectal cancer treated with chemoradiotherapy.
METHODS
We reviewed a total of 421 patients with rectal cancer who underwent neoadjuvant long-course chemoradiotherapy. All lymph nodes were examined retrospectively for evidence of response to chemoradiotherapy, and lymph node regression grade was scored as lymph node regression grade 0 (normal lymph node), lymph node regression grade 1 (100% fibrosis), lymph node regression grade 2 (< 25% cancer cells), lymph node regression grade 3 (25%-50% cancer cells), lymph node regression grade 4 (50%-75% cancer cells), and lymph node regression grade 5 (> 75% cancer cells). The prognostic importance of lymph node regression grade was evaluated.
RESULTS
Among 301 ypN0 patients, 27 patients were scored as lymph node regression grade 1. The 5-year recurrence-free survival and local recurrence rates in lymph node regression grade 1 patients were similar to those in lymph node regression grade 0 patients (96.3% versus 88.1% in recurrence-free survival and 0% versus 2.7% in local recurrence); however, among 120 ypN+ (lymph node regression grade 2-5) patients, the 5-year recurrence-free survival and local recurrence rates were poor regardless of the lymph node regression grade score (38.1%-61.1% in recurrence-free survival and 8.4%-14.0% in local recurrence). In the multivariate analysis, an intensified regimen using systemic chemotherapy was independently associated with more lymph node regression grade 1 (P < .001; odds ratio, 6.06; 95% confidence interval, 2.33-16.20) among patients with lymph node regressions grade 1 through 5. Furthermore, in the multivariate analysis, ypT3-4 (hazard ratio, 7.82; 95% confidence interval, 2.80-27.32; P < .001), lymph node regression grade 1 (hazard ratio, 0.048; 95% confidence interval, 0.002-0.27; P < .001), the number of retrieved lymph nodes < 12 (hazard ratio, 5.48; 95% confidence interval, 1.48-16.38; P = .014), and no perioperative chemotherapy (hazard ratio, 3.01; 95% confidence interval, 1.53-5.68; P = .002) were independent predictors of recurrence-free survival.
CONCLUSION
Complete lymph node regression after chemoradiotherapy is a strong prognostic factor in rectal cancer.
背景
新辅助放化疗后转移性淋巴结消退分级的预后价值仍不清楚。本研究旨在评估直肠癌患者接受放化疗后淋巴结消退分级的预后价值。
方法
我们回顾性分析了 421 例接受新辅助长程放化疗的直肠癌患者。所有淋巴结均进行了回顾性检查，以评估对放化疗的反应，淋巴结消退分级评分为淋巴结消退分级 0（正常淋巴结）、淋巴结消退分级 1（100%纤维化）、淋巴结消退分级 2（<25%癌细胞）、淋巴结消退分级 3（25%-50%癌细胞）、淋巴结消退分级 4（50%-75%癌细胞）和淋巴结消退分级 5（>75%癌细胞）。评估了淋巴结消退分级的预后重要性。
结果
在 301 例 ypN0 患者中，27 例患者被评为淋巴结消退分级 1。淋巴结消退分级 1 患者的 5 年无复发生存率和局部复发率与淋巴结消退分级 0 患者相似（无复发生存率分别为 96.3%和 88.1%，局部复发率分别为 0%和 2.7%）；然而，在 120 例 ypN+（淋巴结消退分级 2-5）患者中，无论淋巴结消退分级评分如何，5 年无复发生存率和局部复发率均较差（无复发生存率分别为 38.1%-61.1%，局部复发率分别为 8.4%-14.0%）。多因素分析显示，在淋巴结消退分级 1 至 5 的患者中，使用全身性化疗的强化方案与更多的淋巴结消退分级 1 独立相关（P<0.001；优势比，6.06；95%置信区间，2.33-16.20）。此外，多因素分析显示，ypT3-4（风险比，7.82；95%置信区间，2.80-27.32；P<0.001）、淋巴结消退分级 1（风险比，0.048；95%置信区间，0.002-0.27；P<0.001）、检出淋巴结数<12（风险比，5.48；95%置信区间，1.48-16.38；P=0.014）和无围手术期化疗（风险比，3.01；95%置信区间，1.53-5.68；P=0.002）是无复发生存的独立预测因素。
结论
放化疗后完全淋巴结消退是直肠癌的一个强有力的预后因素。
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