Lim Byeo Lee, Park In Ja, Kim Young Il, Kim Chan Wook, Lee Jong Lyul, Yoon Yong Sik, Lim Seok-Byung
Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2023 Apr;104(4):205-213. doi: 10.4174/astr.2023.104.4.205. Epub 2023 Mar 31.
PURPOSE: The prognostic significance and treatment of lateral pelvic lymph node metastasis (mLPLN) in rectal cancer patients receiving neoadjuvant chemoradiotherapy (nCRT) are not well understood. In this study, we evaluated the impact of mLPLN identified in imaging modality on outcomes. METHODS: Between January 2008 and December 2016, 1,535 patients who underwent radical resection following nCRT were identified. The association between mLPLN and disease-free survival (DFS), overall survival (OS), local recurrence-free survival (LRFS), and pelvic recurrence-free survival (PRFS) was analyzed, along with risk factors associated with OS and DFS. RESULTS: Overall, 329 (21.4%) of the 1,535 patients experienced disease recurrence; 71 (4.6%) had local recurrence, 25 (1.6%) had pelvic recurrence, and 312 (20.3%) had distant recurrence. The pre- and post-nCRT mLPLN (-) groups had better DFS, LRFS, PRFS, and OS than the (+) groups. LPLN sampling (LPLNs) was implemented in 24.0% of the pre-nCRT mLPLN (+) group and in 28.8% of the post-nCRT mLPLN (+) group. There was no significant difference in OS and LRFS between LPLNs group and no LPLNs group in pre- and post-nCRT mLPLN (+) groups. Pre-nCRT mLPLN was associated with poor OS (hazard ratio [HR], 1.43; P = 0.009) and post-nCRT mLPLN was associated with poor DFS (HR, 1.49; P = 0.002). CONCLUSION: Pre- and post-nCRT mLPLN (+) have different prognostic effects. Post-nCRT mLPLN appears to be more important for disease control. However, pre-nCRT mLPLN should not be disregarded when devising a treatment strategy since it is an independent risk factor for OS.
目的：对于接受新辅助放化疗（nCRT）的直肠癌患者，侧方盆腔淋巴结转移（mLPLN）的预后意义及治疗方法尚未完全明确。在本研究中，我们评估了影像学检查发现的mLPLN对预后的影响。 方法：2008年1月至2016年12月期间，共纳入1535例接受nCRT后行根治性切除术的患者。分析mLPLN与无病生存期（DFS）、总生存期（OS）、局部无复发生存期（LRFS）及盆腔无复发生存期（PRFS）之间的关联，以及与OS和DFS相关的危险因素。 结果：总体而言，1535例患者中有329例（21.4%）出现疾病复发；71例（4.6%）发生局部复发，25例（1.6%）发生盆腔复发，312例（20.3%）发生远处复发。新辅助放化疗前后mLPLN（-）组的DFS、LRFS、PRFS及OS均优于（+）组。新辅助放化疗前mLPLN（+）组中有24.0%进行了侧方盆腔淋巴结取样（LPLNs），新辅助放化疗后mLPLN（+）组中有28.8%进行了该操作。新辅助放化疗前后mLPLN（+）组中，LPLNs组与未进行LPLNs组的OS和LRFS无显著差异。新辅助放化疗前mLPLN与较差的OS相关（风险比[HR]，1.43；P = 0.009），新辅助放化疗后mLPLN与较差的DFS相关（HR，1.49；P = 0.002）。 结论：新辅助放化疗前后mLPLN（+）具有不同的预后影响。新辅助放化疗后mLPLN似乎对疾病控制更为重要。然而，在制定治疗策略时，新辅助放化疗前mLPLN不应被忽视，因为它是OS的独立危险因素。
Int J Clin Oncol. 2019-2-5
Zhonghua Wei Chang Wai Ke Za Zhi. 2020-3-25
Zhonghua Wei Chang Wai Ke Za Zhi. 2019-1-25
World J Gastroenterol. 2020-6-7
Ann Surg Treat Res. 2023-11
Dis Colon Rectum. 2019-10
Ann Gastroenterol Surg. 2018-8-16
Zotero 插件