Chen Bin, Liu Xing, Zhang Yiyi, Zhuang Jinfu, Peng Yong, Wang Ye, Wu Yong, Li Shoufeng, Yang Yuanfeng, Guan Guoxian
Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Front Surg. 2021 Nov 17;8:749575. doi: 10.3389/fsurg.2021.749575. eCollection 2021.
The objective of this study is to assess the prognostic value of lymph node metastasis distribution (LND) in locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (nCRT). This study included 179 patients with pathological stage III LARC who underwent nCRT followed by radical surgery. LND was classified into three groups: LND1, lymph node metastasis at the mesorectum (140/179, 78.2%); LND2, lymph node metastasis along the inferior mesenteric artery trunk nodes (26/179, 14.5%); LND3, lymph node metastasis at the origin of the IMA (13/179, 7.3%). Clinicopathologic characteristics were analyzed to identify independent prognostic factors. LND showed better stratification for 3-year DFS (LND1 66.8, LND2 50, and LND3 15.4%, < 0.01) compared to the ypN (3-year DFS: N1 59.9 and N2 60.3%, = 0.34) and ypTNM (3-year DFS: IIIA 68.6%, IIIB 57.5%, and IIIC 53.5, = 0.19) staging systems. Similar results were found for 3-year LRFS and DMFS. According to multivariate survival analysis, LND was shown to be an independent prognostic factor for DFS, LRFS, and DMFS in patients with positive lymph nodes ( < 0.01, in all cases). LND is an independent prognostic factor in stage III rectal cancer after nCRT. LND can be used as a supplementary indicator for the ypTNM staging system in patients with LARC after nCRT.
本研究的目的是评估新辅助放化疗（nCRT）后局部晚期直肠癌（LARC）中淋巴结转移分布（LND）的预后价值。本研究纳入了179例接受nCRT后行根治性手术的病理III期LARC患者。LND分为三组：LND1，直肠系膜淋巴结转移（140/179，78.2%）；LND2，沿肠系膜下动脉主干淋巴结转移（26/179，14.5%）；LND3，肠系膜下动脉起始处淋巴结转移（13/179，7.3%）。分析临床病理特征以确定独立预后因素。与ypN（3年无病生存率：N1为59.9%，N2为60.3%，P = 0.34）和ypTNM（3年无病生存率：IIIA为68.6%，IIIB为57.5%，IIIC为53.5%，P = 0.19）分期系统相比，LND对3年无病生存率显示出更好的分层（LND1为66.8%，LND2为50%，LND3为15.4%，P<0.01）。3年局部复发无病生存率和远处转移无病生存率也得到了类似结果。根据多因素生存分析，LND被证明是淋巴结阳性患者无病生存率、局部复发无病生存率和远处转移无病生存率的独立预后因素（所有病例P<0.01）。LND是nCRT后III期直肠癌的独立预后因素。LND可作为nCRT后LARC患者ypTNM分期系统的补充指标。
