Chen Nan, Sun Ting-Ting, Li Zhong-Wu, Yao Yun-Feng, Wang Lin, Wu Ai-Wen
Department of Gastrointestinal Surgery, Peking University Cancer Hospital, Beijing 100142, China.
Department of Pathology, Peking University Cancer Hospital, Beijing 100142, China.
World J Gastrointest Oncol. 2019 Oct 15;11(10):877-886. doi: 10.4251/wjgo.v11.i10.877.
As a prognostic factor for colorectal cancer, lymph node (LN) status, particularly the number of LN harvested, has been demonstrated to be essential in the evaluation of quality control in terms of surgical specimen. Neoadjuvant chemoradiation, however, decreases the LN harvest. Therefore, certain approaches (such as fat clearance or methylene blue) has drawn significant attention in order to raise LN yield.
To compare the long-term oncologic outcome of ypN0 rectal cancer identified using fat clearance (FC) or conventional fixation (CF) following 30 Gy in 10 fractions (30 Gy/10f) of neoadjuvant radiotherapy (nRT).
Three hundred and eighty-two patients with resectable and locally advanced rectal cancer were treated by 30 Gy/10f intermediate nRT (biologically equivalent dose of 36 Gy) plus total mesorectal excision. Two specimen fixation methods (FC or CF) were non-randomly used. The ypN0 status was identified in 124 and 101 patients in the FL and CF groups, respectively. Primary endpoints were local recurrence-free survival (LRFS) and cancer-specific survival (CSS).
The median follow-up of patients was 5.1 years. The median numbers of retrieved LNs in the FC and CF groups were 19.5 (range, 4-47) and 12 (range, 0-44), respectively, with a significant difference ( = 0.000). The percentages of patients with 12 or more retrieved nodes were 82.3% and 50.5% (101/159) in the FC and CF groups, respectively, with a significant difference ( = 0.000). The LRFS at 5 years were 95.7% and 94.6% in the FC and CF groups, respectively, without statistical difference ( = 0.819). The CSS at 5 years were 92.0% and 87.2% in the FC and CF groups, respectively, without statistical difference ( = 0.482).
For patients with ypN0 rectal cancer who underwent 30 Gy/10f preoperative radiotherapy, the increased retrieval of LNs using fat clearance is not associated with survival benefit. This time-consuming fixation method has a low efficacy as a routine practice.
作为结直肠癌的一个预后因素，淋巴结（LN）状态，尤其是所获取的LN数量，已被证明在手术标本的质量控制评估中至关重要。然而，新辅助放化疗会减少LN的获取。因此，某些方法（如脂肪清除或亚甲蓝）已引起了极大关注，以提高LN产量。
比较在新辅助放疗（nRT）10次分割给予30 Gy（30 Gy/10f）后，使用脂肪清除（FC）或传统固定（CF）方法确定的ypN0直肠癌患者的长期肿瘤学结局。
382例可切除的局部晚期直肠癌患者接受了30 Gy/10f的中等剂量nRT（生物等效剂量为36 Gy）加全直肠系膜切除术。两种标本固定方法（FC或CF）被非随机使用。FC组和CF组分别有124例和101例患者被确定为ypN0状态。主要终点为无局部复发生存期（LRFS）和癌症特异性生存期（CSS）。
患者的中位随访时间为5.1年。FC组和CF组所获取LN的中位数分别为19.5（范围4 - 47）和12（范围0 - 44），差异有统计学意义（P = 0.000）。FC组和CF组获取12个或更多LN的患者百分比分别为82.3%和50.5%（101/159），差异有统计学意义（P = 0.000）。FC组和CF组5年时的LRFS分别为95.7%和94.6%，无统计学差异（P = 0.819）。FC组和CF组5年时的CSS分别为92.0%和87.2%，无统计学差异（P = 0.482）。
对于接受30 Gy/10f术前放疗的ypN0直肠癌患者，使用脂肪清除增加LN的获取与生存获益无关。这种耗时的固定方法作为常规操作效果不佳。
