Department of Surgical Oncology, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Int J Colorectal Dis. 2020 Apr;35(4):655-664. doi: 10.1007/s00384-020-03520-2. Epub 2020 Feb 3.
This study aimed to clarify predictors and therapeutic significance of inguinal lymph node metastasis (ILNM) in patients with rectal cancer.
Patients with rectal adenocarcinoma invading the anal canal who underwent curative surgery between 2003 and 2019 were retrospectively reviewed. Synchronous and metachronous lymph node (LN) metastasis were collectively defined as final nodal metastasis (f-LNM). Factors associated with f-LNM were analyzed. Moreover, the "modified therapeutic value index," defined by multiplication of the frequency of f-LNM by the 5-year overall survival rate for patients who received treatment for f-LNM, was calculated for each LN area.
A total of 145 patients were enrolled (16 patients with f-ILNM). To predict f-ILNM, the cutoff of the inguinal lymph node (ILN) diameter of 8.5 mm gave an area under the curve of 0.889. Dentate line involvement (odds ratio 33.4) and ILN larger than the cutoff of 8 mm (odds ratio 11.9) were independently associated with f-ILNM. The modified therapeutic value indices of the inguinal, lateral pelvic, and mesorectal LNs in the entire population were 6.1, 8.2, and 20.3 points, respectively. In patients with dentate line invasion by cancer, the index of the ILN increased to 11.7 points. In patients with an ILN > 8 mm, the index further increased to 21.1 points.
Dentate line involvement and ILN > 8 mm predicted the development of ILNM in patients with rectal cancer invading the anal canal. Treatment of the ILN should be considered for patients with the above predictors given the significant therapeutic outcomes.
本研究旨在阐明直肠癌患者腹股沟淋巴结转移（ILNM）的预测因素和治疗意义。
回顾性分析 2003 年至 2019 年间接受根治性手术的肛管直肠癌患者。同步和异时淋巴结（LN）转移统称为终末淋巴结转移（f-LNM）。分析与 f-LNM 相关的因素。此外，为每个 LN 区域计算了“改良治疗价值指数”，该指数通过将 f-LNM 的频率乘以接受 f-LNM 治疗的患者的 5 年总生存率来定义。
共纳入 145 例患者（16 例发生 f-ILNM）。为预测 f-ILNM，腹股沟淋巴结（ILN）直径 8.5mm 的截断值曲线下面积为 0.889。齿状线受累（优势比 33.4）和 ILN 大于 8mm 的截断值（优势比 11.9）与 f-ILNM 独立相关。整个人群的腹股沟、侧盆和中直肠 LN 的改良治疗价值指数分别为 6.1、8.2 和 20.3 分。在癌症侵犯齿状线的患者中，ILN 指数增加到 11.7 分。在 ILN>8mm 的患者中，该指数进一步增加到 21.1 分。
齿状线受累和 ILN>8mm 预测了侵犯肛管的直肠癌患者 ILNM 的发展。对于具有上述预测因素的患者，应考虑治疗 ILN，因为这会带来显著的治疗效果。
