Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai, 200032, China.
Int J Colorectal Dis. 2023 May 6;38(1):115. doi: 10.1007/s00384-023-04415-8.
PURPOSE: Lymph node metastases are uncommon in pT1-2 rectal cancer. pT1-2N1 are often characterized with low tumor burden and intermediate prognosis. Therefore, adjuvant radiotherapy (ART) is controversial in these patients. This study aimed to investigate the value of ART in pT1-2 rectal cancer and evaluate the guiding role of lymph node ratio (LNR) for utilization of ART. METHODS: pT1-2N1 rectal cancer patients who received surgery without neoadjuvant radiotherapy between 2000 and 2018 with at least 12 lymph node harvest were extracted from the Surveillance, Epidemiology and End Results (SEER) database. We used time-dependent receiver operating characteristic (ROC) analysis to determine the optimal cutoff of LNR. Kaplan-Meier methods and Cox proportional hazards regression models were performed to determine the prognostic value of ART in pT1-2N1 rectal cancer patients and subgroups stratified by LNR. RESULTS: A total of 674 and 1321 patients with pT1N1 and pT2N1 rectal cancer were eligible for analysis. There was no statistical cancer-specific survival (CSS) difference in pT1N1 rectal cancer patients between receiving and not receiving ART (P = 0.464). The 5-year CSS was 89.6% and 83.2% in pT2N1 rectal cancer patients between receiving and not receiving ART, respectively (P = 0.003). A total of 7.0% was identified as the optimal cutoff value of LNR. Survival improvement offered by ART was only found in LNR ≥ 7.0% subgroup (5-year CSS: 89.5% versus 79.6%, P = 0.003) instead of LNR < 7.0% subgroup (5-year CSS: 89.9% versus 86.3%, P = 0.208). CONCLUSION: ART show substantial survival benefit in pT2N1 rectal cancer patients with LNR ≥ 7.0%, warranting the conventional adoption of ART in this subgroup.
目的：淋巴结转移在 pT1-2 期直肠癌中并不常见。pT1-2N1 期患者通常具有低肿瘤负荷和中等预后。因此，这些患者的辅助放疗（ART）存在争议。本研究旨在探讨 ART 在 pT1-2 期直肠癌中的价值，并评估淋巴结比率（LNR）对 ART 应用的指导作用。
方法：从监测、流行病学和最终结果（SEER）数据库中提取 2000 年至 2018 年间接受手术且未接受新辅助放疗且至少有 12 个淋巴结检出的 pT1-2N1 期直肠癌患者。我们使用时间依赖性受试者工作特征（ROC）分析来确定 LNR 的最佳截断值。采用 Kaplan-Meier 方法和 Cox 比例风险回归模型，确定 ART 在 pT1-2N1 期直肠癌患者和按 LNR 分层的亚组中的预后价值。
结果：共有 674 例 pT1N1 期和 1321 例 pT2N1 期直肠癌患者符合分析条件。接受和未接受 ART 的 pT1N1 期直肠癌患者的癌症特异性生存率（CSS）无统计学差异（P=0.464）。接受和未接受 ART 的 pT2N1 期直肠癌患者的 5 年 CSS 分别为 89.6%和 83.2%（P=0.003）。确定 7.0%为 LNR 的最佳截断值。仅在 LNR≥7.0%亚组中发现 ART 提供的生存改善（5 年 CSS：89.5%与 79.6%，P=0.003），而在 LNR<7.0%亚组中未发现生存改善（5 年 CSS：89.9%与 86.3%，P=0.208）。
结论：ART 为 LNR≥7.0%的 pT2N1 期直肠癌患者带来显著生存获益，支持在该亚组中常规采用 ART。
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