Lin Yu-Min, Chou Chia-Lin, Kuo Yu-Hsuan, Wu Hung-Chang, Tsai Chia-Jen, Ho Chung-Han, Chen Yi-Chen, Yang Ching-Chieh, Lin Cheng-Wei
Division of Hepatogastroenterology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Division of Colorectal Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
Cancer Manag Res. 2021 Oct 24;13:8037-8047. doi: 10.2147/CMAR.S328666. eCollection 2021.
A lymph node (LN) yield ≥12 is required to for accurate determination of nodal status for colorectal cancer but cannot always be achieved after neoadjuvant therapy. This study aims to determine the difference in LN yield from rectal cancer patients treated with and without neoadjuvant therapy and the effects of specific LN yields on survival.
The study cohort included a total of 4344 rectal cancer patients treated between January 2007 and December 2015, 2260 (52.03%) of whom received neoadjuvant therapy. Data were retrieved from the Taiwan nationwide cancer registry database. The minimum acceptable LN yield below 12 was investigated using the maximum area under the ROC curve.
The median LN yield was 12 (8-17) for patients who received neoadjuvant therapy and 17 (13-24) for those who did not. The recommended LN yield ≥12 was achieved in 82.73% of patients without and 57.96% of those with neoadjuvant therapy ( < 0.0001). Patients with LN yield ≥12 had a higher OS probability than did those with LN <12 (OR, 1.33; 95% CI, 1.06-1.66; = 0.0124). However, the predictive accuracy for survival was greater for LN yield ≥10 (AUC, 0.7767) than cut-offs of 12, 8, or 6, especially in patients with pathologically-negative nodes (AUC, 0.7660).
Neoadjuvant therapy significantly reduces the LN yield in subsequent surgery. A lower yield (LN ≥ 10) may be adequate for nodal evaluation in rectal cancer patients after neoadjuvant therapy.
结直肠癌准确判定淋巴结状态需要获取≥12枚淋巴结，但新辅助治疗后并非总能达到这一标准。本研究旨在确定接受和未接受新辅助治疗的直肠癌患者在淋巴结获取数量上的差异，以及特定淋巴结获取数量对生存的影响。
研究队列共纳入2007年1月至2015年12月期间接受治疗的4344例直肠癌患者，其中2260例（52.03%）接受了新辅助治疗。数据取自台湾全国癌症登记数据库。利用ROC曲线下的最大面积研究低于12枚淋巴结的最低可接受数量。
接受新辅助治疗患者的淋巴结获取数量中位数为12（8 - 17）枚，未接受新辅助治疗患者的为17（13 - 24）枚。未接受新辅助治疗的患者中有82.73%达到了推荐的≥12枚淋巴结获取数量，接受新辅助治疗的患者中这一比例为57.96%（P < 0.0001）。淋巴结获取数量≥12枚的患者总生存概率高于淋巴结获取数量<12枚的患者（OR，1.33；95%CI，1.06 - 1.66；P = 0.0124）。然而，对于生存的预测准确性，淋巴结获取数量≥10枚（AUC，0.7767）高于12、8或6枚的截断值，尤其是在病理淋巴结阴性的患者中（AUC，0.7660）。
新辅助治疗显著降低了后续手术中的淋巴结获取数量。较低的获取数量（淋巴结≥10枚）可能足以用于新辅助治疗后直肠癌患者的淋巴结评估。
