中低位直肠癌侧方淋巴结转移患者侧方盆腔淋巴结清扫的有效清扫范围及预后意义：中国大型多中心侧方淋巴结协作组的结果
Effective dissecting range and prognostic significance of lateral pelvic lymph node dissection for middle-low rectal cancer patients with lateral pelvic lymph node metastasis: Results of a large multicenter lateral node collaborative group in China.
作者信息
Zhou Sicheng, Tang Jianqiang, Liang Jianwei, Lou Zheng, Fu Wei, Feng Bo, Yang Yingchi, Xiao Yi, Liu Qian
机构信息
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Colorectal Surgery, The first affiliated hospital, Navy Medical University, Shanghai, China.
出版信息
Front Oncol. 2022 Aug 12;12:916285. doi: 10.3389/fonc.2022.916285. eCollection 2022.
BACKGROUND
Lateral pelvic lymph node (LPN) metastasis causes increased lateral local recurrence and poor prognosis. We aimed to investigate the prognostic significance and effective range of dissection for the LPN dissection (LPND) in rectal cancer patients with LPN metastasis.
MATERIALS AND METHODS
Through this large, multicenter retrospective cohort study, we evaluated the therapeutic effect of LPND. From January 2012 to December 2019, 387 rectal cancer patients with clinical evidence of LPN metastasis who underwent total mesorectal excision with LPND were included in the study. According to pathological findings, they were divided into negative (n = 296) and positive (n = 91) LPN groups. Primary endpoints were 3-year overall survival (OS), recurrence-free survival (RFS), and local recurrence-free survival (LRFS).
RESULTS
The OS, RFS, and LRFS in the positive group were significantly worse than those in the negative group; However, LPN metastases were not independent prognostic risk factors for LRFS (hazard ratio [HR]: 2.42; 95% confidence interval [CI], 0.77-7.64; =0.132). Among patients with pathological LPN metastases, LPN metastases to the common and external iliac arteries were independent prognostic risk factors both for OS (HR: 4.74; 95% CI, 1.74-12.90; =0.002) and RFS (HR: 2.70; 95% CI, 1.16-6.29; =0.021). No significant difference was observed in the 3-year OS (72.3% vs. 70.2%, =0.775) and RFS rates (60.9% vs. 52.6%, =0.408) between patients with metastases to the obturator or internal iliac arteries and patients at N2b stage.
CONCLUSIONS
LPND may be effective in controlling local recurrence in patients with LPN metastasis but not systemic metastases. Patients with LPN metastasis limited to the internal iliac and obturator regions achieve a long-term survival benefit from LPND, and their prognoses may be comparable to those at the N2b stage. Further metastasis to the external iliac or common iliac region should be considered systemic disease, and LPND should be avoided.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov, identifier NCT04850027.
背景
侧方盆腔淋巴结（LPN）转移会导致侧方局部复发增加且预后不良。我们旨在探讨LPN清扫术（LPND）在伴有LPN转移的直肠癌患者中的预后意义及有效清扫范围。
材料与方法
通过这项大型多中心回顾性队列研究，我们评估了LPND的治疗效果。2012年1月至2019年12月，纳入387例有LPN转移临床证据且接受了LPND的全直肠系膜切除术的直肠癌患者。根据病理结果，将他们分为LPN阴性组（n = 296）和阳性组（n = 91）。主要终点为3年总生存（OS）、无复发生存（RFS）和无局部复发生存（LRFS）。
结果
阳性组的OS、RFS和LRFS显著差于阴性组；然而，LPN转移不是LRFS的独立预后危险因素（风险比[HR]：2.42；95%置信区间[CI]，0.77 - 7.64；P = 0.132）。在有病理LPN转移的患者中，LPN转移至髂总动脉和髂外动脉是OS（HR：4.74；95% CI，1.74 - 12.90；P = 0.002）和RFS（HR：2.70；95% CI，1.16 - 6.29；P = 0.021）的独立预后危险因素。闭孔或髂内动脉转移患者与N2b期患者的3年OS率（72.3%对70.2%，P = 0.775）和RFS率（60.9%对52.6%，P = 0.408）无显著差异。
结论
LPND可能对控制LPN转移患者的局部复发有效，但对全身转移无效。LPN转移局限于髂内和闭孔区域的患者可从LPND中获得长期生存益处，其预后可能与N2b期患者相当。进一步转移至髂外或髂总区域应视为全身性疾病，应避免行LPND。
临床试验注册
ClinicalTrials.gov，标识符NCT04850027。
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