局部进展期低位直肠癌治疗前侧方淋巴结转移灶中存在恶性特征可预测远处转移。

Malignant Features in Pretreatment Metastatic Lateral Lymph Nodes in Locally Advanced Low Rectal Cancer Predict Distant Metastases.

机构信息

Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia.

Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.

出版信息

Ann Surg Oncol. 2022 Feb;29(2):1194-1203. doi: 10.1245/s10434-021-10762-z. Epub 2021 Sep 6.

DOI:10.1245/s10434-021-10762-z

PMID:34490529

Abstract

INTRODUCTION

Pretreatment enlarged lateral lymph nodes (LLN) in patients with locally advanced low rectal cancer are predictive for local recurrences after neoadjuvant (chemo)radiotherapy (n(C)RT) followed by total mesorectal excision (TME). Not much is known of the impact on oncological outcomes when in addition malignant features are present in enlarged LLN.

PATIENTS AND METHODS

A multicenter retrospective cohort study was conducted at five tertiary referral centers in the Netherlands and Australia. All patients were diagnosed with locally advanced low rectal cancer with LLN on pretreatment magnetic resonance imaging (MRI) and underwent n(C)RT followed by TME. LLN were considered enlarged with a short axis of ≥ 5 mm. Malignant features were defined as nodes with internal heterogeneity and/or border irregularity. Outcomes of interest were local recurrence-free survival (LRFS), distant metastatic-free survival (DMFS), and overall survival (OS).

RESULTS

Out of 115 patients, the majority was male (75%) and the median age was 64 years (range 26-85 years). Median pretreatment LLN short axis was 7 mm (range 5-28 mm), and 60 patients (52%) had malignant features. After a median follow-up of 47 months, patients with larger LLN (7 + mm) had a worse LRFS (p = 0.01) but no difference in DMFS (p = 0.37) and OS (p = 0.54) compared with patients with smaller LLN (5-6 mm). LLN patients with malignant features had no difference in LRFS (p = 0.20) but worse DMFS (p = 0.004) and OS (p = 0.006) compared with patients without malignant features in the LLN. Cox regression analysis identified LLN short axis as an independent factor for LR. Malignant features in LLN were an independent factor for DMFS.

CONCLUSION

The current study suggests that pretreatment enlarged LLN that also harbor malignant features are predictive of a worse DMFS. More studies will be required to further explore the role of malignant features in LLN.

摘要

简介

局部晚期低位直肠癌患者治疗前增大的侧方淋巴结（LLN）可预测新辅助（放）化疗后行全直肠系膜切除术（TME）前的局部复发。然而，当增大的 LLN 中存在恶性特征时，其对肿瘤学结局的影响尚不清楚。

患者和方法

本研究在荷兰和澳大利亚的五家三级转诊中心进行了一项多中心回顾性队列研究。所有患者均在治疗前磁共振成像（MRI）上诊断为局部晚期低位直肠癌，伴有 LLN，并接受新辅助（放）化疗后行 TME。LLN 的短轴直径≥5mm 被认为是增大的。恶性特征定义为淋巴结内部异质性和/或边界不规则。感兴趣的结局包括局部无复发生存率（LRFS）、远处无转移生存率（DMFS）和总生存率（OS）。

结果

在 115 名患者中，大多数为男性（75%），中位年龄为 64 岁（范围 26-85 岁）。治疗前 LLN 的短轴直径中位数为 7mm（范围 5-28mm），60 名患者（52%）存在恶性特征。中位随访 47 个月后，LLN 较大（7+mm）的患者 LRFS 更差（p=0.01），但 DMFS（p=0.37）和 OS（p=0.54）无差异。与 LLN 较小（5-6mm）的患者相比。LLN 存在恶性特征的患者在 LRFS 方面无差异（p=0.20），但 DMFS（p=0.004）和 OS（p=0.006）更差。Cox 回归分析确定 LLN 短轴是 LR 的独立因素。LLN 中的恶性特征是 DMFS 的独立因素。