Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi, Japan.
Jpn J Clin Oncol. 2021 Apr 30;51(5):713-721. doi: 10.1093/jjco/hyaa265.
Metastatic lateral pelvic nodes represent an important cause of pelvic recurrence in low rectal cancer patients even after preoperative chemoradiotherapy. This study aimed to evaluate the prognostic benefit of an upfront lateral pelvic nodes dissection strategy.
A total of 175 consecutive patients with stage II/III low rectal adenocarcinoma who underwent mesorectal excision with lateral pelvic nodes dissection between 1998 and 2013 were identified. Regional lateral pelvic nodes were categorized as LD2 nodes (internal iliac, hypogastric and obturator) and LD3 nodes (external iliac, common iliac, lateral sacral, presacral and sacral promontory) according to the current Japanese Society for Cancer of the Colon and Rectum classification.
Five-year cumulative risks of local recurrence and recurrence-free survival were 4.8% and 78.1% for stage II patients, and 11.8% and 61.7% for stage III patients, respectively. Among stage III patients, no differences were observed in cumulative risks of local recurrence (5 years: 9.3% vs 14.7%, P= 0.463) and recurrence-free survival (5 years: 65.1 vs 61.2%, P = 0.890) between lateral pelvic nodes (-) and LD2 (+) patients. In multivariate analyses, metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence (hazard ratioadj: 1.389; 95% confidence interval: 0.409-4.716) and recurrence-free survival (hazard ratioadj: 0.884; 95% confidence interval: 0.425-1.837).
Metastatic lateral pelvic nodes had no impact on cumulative risks of local recurrence and recurrence-free survival based on an upfront lateral pelvic nodes strategy. Lateral pelvic nodes can improve recurrence and survival outcomes in locally advanced low rectal cancer patients with metastatic lateral pelvic nodes.
转移性侧盆淋巴结是低位直肠癌患者即使在术前放化疗后发生骨盆局部复发的重要原因。本研究旨在评估 upfront 侧盆淋巴结清扫策略的预后获益。
1998 年至 2013 年间，共纳入 175 例接受中低位直肠腺癌直肠系膜切除术联合侧盆淋巴结清扫术的 II/III 期低位直肠癌患者。根据当前日本结直肠癌协会的分类，区域侧盆淋巴结分为 LD2 淋巴结（髂内、下腹和闭孔）和 LD3 淋巴结（髂外、髂总、骶外侧、骶前和骶骨岬）。
对于 II 期患者，5 年局部复发累积风险和无复发生存率分别为 4.8%和 78.1%；对于 III 期患者，分别为 11.8%和 61.7%。在 III 期患者中，侧盆淋巴结阴性和 LD2 阳性患者的局部复发累积风险（5 年：9.3% vs 14.7%，P=0.463）和无复发生存率（5 年：65.1% vs 61.2%，P=0.890）均无差异。多因素分析显示，转移性侧盆淋巴结对局部复发累积风险（风险比 adj：1.389；95%置信区间：0.409-4.716）和无复发生存率（风险比 adj：0.884；95%置信区间：0.425-1.837）均无影响。
基于 upfront 侧盆淋巴结策略，转移性侧盆淋巴结对局部复发累积风险和无复发生存率无影响。在转移性侧盆淋巴结的局部晚期低位直肠癌患者中，侧盆淋巴结清扫可改善复发和生存结局。
