Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan.
Department of Gastrointestinal Surgery, Kanagawa Cancer Centre, Kanagawa, Japan.
Br J Surg. 2020 Jul;107(8):1070-1078. doi: 10.1002/bjs.11517. Epub 2020 Apr 4.
Whether tumour side affects the anatomical extent and distribution of lymph node metastasis in colon cancer is unknown. The impact of tumour side on the anatomical pattern of lymphatic spread in colon cancer was assessed.
Patients with stage III colon cancer from a Japanese multi-institutional database who underwent extensive (D3) lymphadenectomy, which is similar in concept to complete mesocolic excision with central venous ligation, were divided into groups with right- and left-sided tumours. Based on location, mesenteric lymph nodes were categorized as paracolic (L1), intermediate (L2) or central (L3). The Kaplan-Meier method was used to evaluate disease-free survival (DFS) and overall survival (OS), and multivariable Cox models were used to evaluate the association between anatomical lymph node level, metastatic pattern and outcome.
A total of 4034 patients with stage III colon cancer (right 1618, left 2416) were included. Unadjusted OS was worse in patients with right colon cancer (hazard ratio 1·23, 95 per cent c.i. 1·08 to 1·40; P = 0·002), but DFS was similar. Right-sided tumours more frequently invaded L3 nodes than left-sided lesions (8·5 versus 3·7 per cent; P < 0·001). The proportion of patients with a skipped pattern of lymphatic spread was higher in right than in left colon cancer (13·7 versus 9·0 per cent; P < 0·001). In multivariable analysis, invasion of L3 nodes was associated with worse OS in left but not in right colon cancer. The presence of skipped metastasis was associated with worse DFS in left, but not right, colon cancer.
There are significant differences in the pattern of lymph node invasion between right- and left-sided stage III colon cancer, and in their prognostic significance, suggesting that tumour side may dictate the operative approach.
肿瘤侧是否影响结肠癌的淋巴结转移的解剖范围和分布尚不清楚。本研究评估了肿瘤侧对结肠癌淋巴扩散解剖模式的影响。
来自日本多机构数据库的 III 期结肠癌患者接受广泛（D3）淋巴结清扫术，该手术概念上类似于完整结肠系膜切除伴中央静脉结扎术，患者被分为右半结肠癌组和左半结肠癌组。基于位置，肠系膜淋巴结分为结肠旁（L1）、中间（L2）或中央（L3）。采用 Kaplan-Meier 法评估无病生存（DFS）和总生存（OS），多变量 Cox 模型评估解剖淋巴结水平、转移模式与预后的关系。
共纳入 4034 例 III 期结肠癌患者（右半结肠癌 1618 例，左半结肠癌 2416 例）。未校正的 OS 右半结肠癌患者较差（风险比 1.23，95%可信区间 1.08 至 1.40；P=0.002），但 DFS 无差异。右半结肠癌更常侵犯 L3 淋巴结（8.5%比 3.7%；P<0.001）。右半结肠癌跳跃式淋巴转移的比例高于左半结肠癌（13.7%比 9.0%；P<0.001）。多变量分析显示，L3 淋巴结侵犯与左半结肠癌的 OS 较差相关，但与右半结肠癌无关。跳跃性转移的存在与左半结肠癌的 DFS 较差相关，但与右半结肠癌无关。
右半和左半 III 期结肠癌的淋巴结侵犯模式存在显著差异，且其预后意义也不同，这表明肿瘤侧可能决定手术方式。
