Otmani Ihsane El, Effared Boubacar, Agy Fatima El, Abkari Mohammed El, Mazaz Khalid, Benjelloun El Bachir, Ousadden Abdelmalek, Benbrahim Zineb, Bouhafa Touria, Chbani Laila
Laboratory of Biomedical and Translational Research, Faculty of Medicine and Pharmacy of Fez, University Sidi Mohamed BenAbdellah, Fez, Morocco.
Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat, Morocco.
Clin Pathol. 2022 Oct 31;15:2632010X221132974. doi: 10.1177/2632010X221132974. eCollection 2022 Jan-Dec.
In patients with locally advanced rectal cancer, neoadjuvant radiotherapy or chemoradiotherapy followed by total mesorectal excision as a standard of care. We aimed to explore the number, size, germinal centers, extracapsular invasion of lymph nodes (LN), and their impact on overall survival and disease free survival. Furthermore we also investigated the characteristics of lymph nodes in patients who received neoadjuvant therapy and those who underwent surgery between 2011 and 2018. The count and measurement of lymph nodes was assessed by careful visual inspection and manual palpation. The predictive cut-off value of the lymph node ratio (LNR) was determined based on the receiver operating characteristic (ROC), method and the survival outcomes based on Kaplan-Meier curves. We found that the size and the number of lymph nodes decreased significantly after neoadjuvant treatment. The mean LN for patients who received neoadjuvant therapy was 12.68 ± 6.69 and for patients who did not receive neoadjuvant therapy was 16.29 ± 5.61 ( = .012). The average size for patients who received neoadjuvant therapy followed by surgery was 3.30 ± 1.10 versus 4.22 ± 1.18 mm for control group (surgery only) ( < .001), an LNR of 0.13 (sensitivity: 86%, specificity: 47%, AUC: 60%, 95% CI, 0.41%-0.76%) predicted recurrence and metastasis. Presence of lymph nodes with germinal centers was significantly associated with absence of vascular invasion, nodal tumor deposits, distant metastasis, and lower age group (<50 years). However there was no association seen between overall survival and relapse free, total number of lymph nodes enlarged and extracapsular invasion in positive nodes. Finally there is no association between lymph nodes with germinal centers and tumor response after neoadjuvant treatment in locally advanced rectal cancer.
在局部晚期直肠癌患者中，新辅助放疗或放化疗后行全直肠系膜切除术是标准治疗方案。我们旨在探究淋巴结的数量、大小、生发中心、淋巴结包膜外侵犯情况及其对总生存和无病生存的影响。此外，我们还调查了2011年至2018年间接受新辅助治疗患者和接受手术患者的淋巴结特征。通过仔细的视觉检查和手动触诊来评估淋巴结的计数和测量。基于受试者工作特征（ROC）方法确定淋巴结比率（LNR）的预测临界值，并根据Kaplan-Meier曲线确定生存结局。我们发现新辅助治疗后淋巴结的大小和数量显著减少。接受新辅助治疗患者的平均淋巴结数为12.68±6.69，未接受新辅助治疗患者的平均淋巴结数为16.29±5.61（P = 0.012）。接受新辅助治疗后再行手术患者的平均淋巴结大小为3.30±1.10mm，而对照组（仅手术）为4.22±1.18mm（P < 0.001），LNR为0.13（敏感性：86%，特异性：47%，AUC：60%，95%CI，0.41%-0.76%）可预测复发和转移。有生发中心的淋巴结的存在与无血管侵犯、淋巴结肿瘤沉积物、远处转移以及较低年龄组（<50岁）显著相关。然而，总生存和无复发生存、肿大淋巴结总数以及阳性淋巴结的包膜外侵犯之间未见关联。最后，在局部晚期直肠癌中，有生发中心的淋巴结与新辅助治疗后的肿瘤反应之间无关联。
