Zeng De-Xing, Yang Zhou, Tan Ling, Ran Meng-Ni, Liu Zi-Lin, Xiao Jiang-Wei
Department of Gastrointestinal Surgery, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
Department of Gastrointestinal Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Front Oncol. 2023 Sep 6;13:1219608. doi: 10.3389/fonc.2023.1219608. eCollection 2023.
Lateral pelvic lymph node (LPLN) metastasis is one of the prominent reasons for local recurrence (LR) in patients with rectal cancer (RC). The evaluation criteria of lateral lymph node dissection (LLND) for patients in eastern (mainly in Japan) and western countries have been controversial. The aim of this study was to analyse the risk factors for LPLN metastasis in order to guide surgical methods.
We searched relevant databases (Embase (Ovid), Medline (Ovid), PubMed, Cochrane Library, and Web of Science) for articles published between 1 January 2000 and 05 October 2022 to evaluate the risk factors for LPLN metastasis in patients with RC in this meta-analysis.
A total of 24 articles with 5843 patients were included in this study. The overall results showed that female sex, age <60 years, pretherapeutic CEA level >5 ng/ml, clinical T4 stage (cT4), clinical M1 stage (cM1), distance of the tumour from the anal verge (AV) <50 mm, tumour centre located below the peritoneal reflection (Rb), short axis (SA) of LPLN ≥8 mm before nCRT, short axis (SA) of LPLN ≥5 mm after nCRT, border irregularity of LPLN, tumour size ≥50 mm, pathological T3-4 stage (pT3-4), pathological N2 stage (pN2), mesorectal lymph node metastasis (MLNM), lymphatic invasion (LI), venous invasion (VI), CRM (+) and poor differentiation were significant risk factors for LPLN metastasis (P <0.05).
This study summarized almost all potential risk factors of LPLN metastasis and expected to provide effective treatment strategies for patients with LRC. According to the risk factors of lateral lymph node metastasis, we can adopt different comprehensive treatment strategies. High-risk patients can perform lateral lymph node dissection to effectively reduce local recurrence; In low-risk patients, we can avoid overtreatment, reduce complications and trauma caused by lateral lymph node dissection, and maximize patient survival and quality of life.
侧方盆腔淋巴结（LPLN）转移是直肠癌（RC）患者局部复发（LR）的主要原因之一。东西方国家（主要是日本）对直肠癌患者侧方淋巴结清扫（LLND）的评估标准一直存在争议。本研究旨在分析LPLN转移的危险因素，以指导手术方法。
我们检索了相关数据库（Embase（Ovid）、Medline（Ovid）、PubMed、Cochrane图书馆和Web of Science），查找2000年1月1日至2022年10月5日期间发表的文章，以评估本荟萃分析中RC患者LPLN转移的危险因素。
本研究共纳入24篇文章，涉及5843例患者。总体结果显示，女性、年龄<60岁、治疗前癌胚抗原（CEA）水平>5 ng/ml、临床T4期（cT4）、临床M1期（cM1）、肿瘤距肛缘（AV）距离<50 mm、肿瘤中心位于腹膜返折以下（Rb）、新辅助放化疗（nCRT）前LPLN短轴（SA）≥8 mm、nCRT后LPLN短轴（SA）≥5 mm、LPLN边界不规则、肿瘤大小≥50 mm、病理T3-4期（pT3-4）、病理N2期（pN2）、直肠系膜淋巴结转移（MLNM）、淋巴管侵犯（LI）、静脉侵犯（VI）、环周切缘阳性（CRM(+)）及低分化是LPLN转移的显著危险因素（P<0.05）。
本研究总结了几乎所有LPLN转移的潜在危险因素，期望为局部复发直肠癌患者提供有效的治疗策略。根据侧方淋巴结转移的危险因素，我们可以采取不同的综合治疗策略。高危患者可行侧方淋巴结清扫以有效降低局部复发；低危患者可避免过度治疗，减少侧方淋巴结清扫引起的并发症和创伤，最大限度提高患者生存率和生活质量。
