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新辅助化疗联合放化疗对直肠腺癌淋巴结的影响。

Effects of neoadjuvant chemotherapy plus chemoradiotherapy on lymph nodes in rectal adenocarcinoma.

机构信息

Department of Pathology, Pellegrin Hospital, CHU Bordeaux, Place Amélie Raba-Léon, 33076, Bordeaux, France.

Department of Colorectal Surgery, Haut-Lévêque Hospital, CHU Bordeaux, Bordeaux, France.

出版信息

Virchows Arch. 2021 Oct;479(4):657-666. doi: 10.1007/s00428-021-03108-3. Epub 2021 May 13.

Abstract

The pathological nodal stage, determination of which requires examination of ≥ 12 lymph nodes, is one of the main prognostic factors in rectal cancer. Neoadjuvant chemoradiotherapy (CRT) may reduce the number of both lymph nodes retrieved and positive lymph nodes. Induction chemotherapy before CRT aimed at reducing the rate of distant metastases. However, the impact of this new treatment on number of lymph nodes retrieved and positive lymph nodes is unknown. This study was performed to evaluate the effects of neoadjuvant chemotherapy on lymph nodes in locally advanced rectal cancer treated by CRT. We retrospectively included patients with T2 - 4 Nx M0 rectal cancer and compared those receiving neoadjuvant chemotherapy plus CRT with those receiving CRT alone. From 2012 to 2019, 85 patients were treated with neoadjuvant chemotherapy + CRT and 189 with CRT alone. The number of lymph nodes retrieved (19 vs. 17, respectively, P = 0.434), the rate of specimens with ≥ 12 lymph nodes (92% vs. 88%, respectively, P = 0.397), and the median number of positive lymph nodes (1 vs. 2, respectively, P = 0.878) were similar between the two groups. However, the rate of pN0 was higher after neoadjuvant chemotherapy + CRT compared to CRT (75% vs. 62%, respectively, P = 0.030). Neoadjuvant chemotherapy before CRT for locally advanced rectal cancer did not modify the number of lymph nodes retrieved or the number of positive lymph nodes compared to CRT alone. However, it significantly increased the rate of tumors without any positive lymph nodes (ypN0).

摘要

病理淋巴结分期需要检查≥12 个淋巴结,是直肠癌的主要预后因素之一。新辅助放化疗(CRT)可能会减少检出的淋巴结和阳性淋巴结的数量。CRT 前的诱导化疗旨在降低远处转移率。然而,这种新治疗方法对检出的淋巴结和阳性淋巴结数量的影响尚不清楚。本研究旨在评估新辅助化疗对接受 CRT 治疗的局部晚期直肠癌淋巴结的影响。我们回顾性纳入 T2-4NxM0 局部进展期直肠癌患者,并比较了接受新辅助化疗+CRT 与单独接受 CRT 的患者。2012 年至 2019 年,85 例患者接受新辅助化疗+CRT,189 例患者单独接受 CRT。两组患者检出的淋巴结数量(分别为 19 个和 17 个,P=0.434)、有≥12 个淋巴结的标本比例(分别为 92%和 88%,P=0.397)和阳性淋巴结的中位数(分别为 1 个和 2 个,P=0.878)相似。然而,新辅助化疗+CRT 组的 pN0 率高于单独 CRT 组(分别为 75%和 62%,P=0.030)。局部晚期直肠癌 CRT 前新辅助化疗与单独 CRT 相比,并未改变检出的淋巴结数量或阳性淋巴结数量。然而,它显著增加了无任何阳性淋巴结(ypN0)的肿瘤比例。

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