比较不同手术解剖层面隐匿性肿瘤细胞和淋巴结转移状态对 I-III 期右半结肠癌患者再分层前后 5 年生存率的影响。

Comparing 5-Year Survival Rates Before and After Re-stratification of Stage I-III Right-Sided Colon Cancer Patients by Establishing the Presence/Absence of Occult Tumor Cells and Lymph Node Metastases in the Different Levels of Surgical Dissection.

机构信息

Department of Digestive Surgery, Akershus University Hospital HF, Postboks 1000, 1478, Lorenskog, Norway.

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.

出版信息

J Gastrointest Surg. 2022 Oct;26(10):2201-2211. doi: 10.1007/s11605-022-05434-6. Epub 2022 Aug 29.

DOI:10.1007/s11605-022-05434-6

PMID:36036877

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9568470/

Abstract

BACKGROUND

To establish the impact of re-stratification on the outcomes of patients (stage I-III right-sided colon cancer) based on the presence/absence of occult tumor cells (OTC) and/or metastatic lymph nodes in the different levels of surgical dissection.

METHODS

Consecutive patients were drawn from a multicenter prospective trial. After surgery, the surgical specimen was divided into the D1/D2 and D3 volumes before being further analyzed separately. All lymph nodes were examined with cytokeratin CAM 5.2 immunohistochemically. Lymph nodes containing metastases and OTC (micrometastases; isolated tumor cells) were identified. Re-stratification was as follows: RS1, stages I/II, no OTC in D1/D2 and D3 volumes; RS2, stages I/II, OTC in D1/D2 and/or D3; RS3, stage III, lymph node metastases in D1/D2, with/without OTC in D3; RS4, stage III, lymph node metastases in D3, with/without OTC in D3.

RESULTS

Eighty-seven patients (39 men, 68.4 + 9.9 years) were included. The standard stratified (SS) group contained the following: stages I/II (SS1) 57 patients; stage III (SS2) 30 patients. Re-stratified (RS) contained RS1 (38), RS2 (19), RS3 (24), and RS4 (6) patients. Lymph node ratio (OTC) RS2: 0.157 D1/D2; 0.035 D3 and 0.092 complete specimens. Lymph node ratio RS3: 0.113 D1/D2; complete specimen 0.056. Overall survival and disease-free survival were p = 0.875 and p = 0.049 for SS and p = 0.144 and p = 0.001 for RS groups, respectively.

CONCLUSION

This re-stratification identifies a patient group with poor prognosis (RS4). Removing this group from SS2 eliminates all the differences in survival between RS2 and RS3 groups. The level of dissection of the affected nodes may have an impact on survival.

CLINICAL TRIAL

"Safe Radical D3 Right Hemicolectomy for Cancer through Preoperative Biphasic Multi-Detector Computed Tomography (MDCT) Angiography" registered at http://clinicaltrials.gov/ct2/show/NCT01351714.

摘要

背景

基于手术不同解剖层面隐匿肿瘤细胞（OTC）和/或转移性淋巴结的存在与否，确定再分层对（I-III 期右侧结肠癌）患者结局的影响。

方法

连续纳入来自多中心前瞻性试验的患者。手术后，将手术标本分为 D1/D2 和 D3 体积，然后分别进行进一步分析。所有淋巴结均用细胞角蛋白 CAM 5.2 免疫组化进行检查。识别含有转移和 OTC（微转移；孤立肿瘤细胞）的淋巴结。再分层如下：RS1，I/II 期，D1/D2 和 D3 体积中无 OTC；RS2，I/II 期，D1/D2 和/或 D3 中存在 OTC；RS3，III 期，D1/D2 中有淋巴结转移，D3 中有/无 OTC；RS4，III 期，D3 中有淋巴结转移，D3 中有/无 OTC。

结果

共纳入 87 例患者（39 名男性，68.4±9.9 岁）。标准分层（SS）组包括以下内容：I/II 期（SS1）57 例；III 期（SS2）30 例。再分层（RS）包括 RS1（38 例）、RS2（19 例）、RS3（24 例）和 RS4（6 例）。淋巴结比值（OTC）RS2：D1/D2 为 0.157；D3 和完整标本为 0.035；RS3：D1/D2 为 0.113；完整标本为 0.056。总生存和无病生存 SS 组 p=0.875 和 p=0.049，RS 组 p=0.144 和 p=0.001。