结直肠癌根治性切除术后的肿瘤顶端淋巴结转移的临床影响
The Clinical Impact of Apical Lymph Node Metastasis of Colorectal Cancer After Curative Resection.
机构信息
Department of Surgery, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 840-8571, Japan.
Life Science Research Institution, Saga Medical Center Koseikan, 400 Nakabaru, Kasemachi, Saga City, Saga, 840-8571, Japan.
出版信息
J Gastrointest Cancer. 2023 Jun;54(2):506-512. doi: 10.1007/s12029-022-00828-w. Epub 2022 Apr 29.
PURPOSE
The present study aimed to investigate the clinical implications of apical lymph node metastasis (ALNM) after curative resection of stage III colorectal cancer.
METHODS
A retrospective study was conducted of 1403 consecutive colorectal cancer patients who underwent surgical resection at a single institution between April 2008 and January 2020. The characteristics of ALNM, the recurrence status and the relapse-free survival (RFS) were examined.
RESULTS
The numbers of patients with stage ≤ I, II, III, and IV disease were 350, 437, 476, and 140 patients, respectively. Among these patients with stage III disease, ALNM was seen in 21 patients (4.4% of stage III patients). Among them, curative resection was performed in 19 patients. Recurrence was observed in 68% (13/19) of the patients with ALNM who received curative resection. The first sites of recurrence included the lymph nodes 53.8% (7/13), liver 30.8% (4/13), lung 15.4% (2/13), brain 7.7% (1/13), bone 7.7% (1/13), and peritoneum 7.7% (1/13). There was no significant difference in the RFS of patients with ALNM who were managed with or without adjuvant chemotherapy (P = 0.207). Furthermore, the RFS of the group managed without adjuvant chemotherapy and the group that received adjuvant chemotherapy with/without oxaliplatin did not differ to a statistically significant extent (P = 0.318). In stage III colorectal cancer patients with ALNM, recurrence was observed significantly more frequently in comparison to stage III colorectal cancer patients without ALNM (P = 0.007). The first site of recurrence in patients with ALNM was most frequently seen in the distant lymph nodes (P = 0.004).
CONCLUSION
Our findings suggest that ALNM is strongly associated with recurrence in the distant lymph nodes and that it may lead to the development of systemic disease. The current regimen for stage III colorectal cancer may therefore not be sufficient for patients with stage III ALNM.
目的
本研究旨在探讨根治性切除术后Ⅲ期结直肠癌患者的肛侧淋巴结转移（ALNM）的临床意义。
方法
对 2008 年 4 月至 2020 年 1 月在一家医疗机构接受手术切除的 1403 例连续结直肠癌患者进行回顾性研究。检查 ALNM 的特征、复发情况和无复发生存率（RFS）。
结果
患者的分期分别为≤Ⅰ期 350 例、Ⅱ期 437 例、Ⅲ期 476 例和Ⅳ期 140 例。其中，Ⅲ期患者中 ALNM 患者 21 例（Ⅲ期患者的 4.4%）。其中 19 例接受了根治性切除。接受根治性切除的 ALNM 患者中有 68%（13/19）发生了复发。复发的第一部位包括淋巴结 53.8%（13/13）、肝 30.8%（4/13）、肺 15.4%（2/13）、脑 7.7%（1/13）、骨 7.7%（1/13）和腹膜 7.7%（1/13）。接受或未接受辅助化疗的 ALNM 患者的 RFS 无显著差异（P=0.207）。此外，未接受辅助化疗的患者的 RFS 与接受奥沙利铂辅助化疗的患者或未接受奥沙利铂辅助化疗的患者之间无统计学差异（P=0.318）。在有 ALNM 的Ⅲ期结直肠癌患者中，与无 ALNM 的Ⅲ期结直肠癌患者相比，复发更为常见（P=0.007）。ALNM 患者的复发第一部位最常发生在远处淋巴结（P=0.004）。
结论
我们的研究结果表明，ALNM 与远处淋巴结的复发密切相关，可能导致全身疾病的发展。目前的Ⅲ期结直肠癌治疗方案可能不足以治疗有 ALNM 的患者。
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