新辅助放化疗能否改善临床怀疑侧方淋巴结转移的直肠癌患者侧方淋巴结清扫术的局部控制和预后？中国多中心侧方淋巴结研究。

Can neoadjuvant chemoradiotherapy before lateral pelvic lymph node dissection improve local control and prognosis in rectal cancer patients with clinically suspected lateral lymph node metastasis? A multicenter lateral node study in China.

机构信息

Department of Gastrointestinal and Colorectal Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.

Department of Colorectal Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer,, Sun Yat-sen University Cancer Center, Guangzhou, China.

出版信息

BMC Cancer. 2024 Jan 23;24(1):115. doi: 10.1186/s12885-024-11867-w.

DOI:10.1186/s12885-024-11867-w

PMID:38263067

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10804599/

Abstract

AIMS

Selective lateral pelvic lymph node (LPN) dissection (LPND) following neoadjuvant chemoradiotherapy (nCRT) for rectal cancer is widely recognized. This study aimed to determine the effects of nCRT before LPND on local control and prognosis of rectal cancer patients.

MATERIALS AND METHODS

Data were retrieved from a prospective database for rectal cancer patients with clinical LPN metastasis receiving total mesorectal excision and LPND at three institutions between January 2012 and December 2019. Selection bias was minimized using propensity score matching (PSM) and short-term and clinical outcomes were compared.

RESULTS

Patients (n = 213) were enrolled and grouped as either nCRT (n = 97) or non-nCRT (n = 116). PSM was used to identify 83 matched pairs. In the matched cohort, nCRT patients had a longer operation duration (310.6 vs. 265.0 min, P = 0.001), lower pathological LPN metastasis rate (32.5% vs. 48.2%, P = 0.040), and fewer harvested lymph nodes (22 vs. 25, P = 0.018) compared to the non-nCRT group. However, after PSM, the two groups had similar estimated overall 3-year survival (79.5% vs. 80.7%, P = 0.922), 3-year disease-free survival (66.1% vs. 65.5, P = 0.820), and 3-year local recurrence-free survival (88.6% vs. 89.7%, P = 0.927). Distant metastasis was the predominant recurrence pattern in the overall (45/58, 77.6%) and matched (33/44, 75.0%) cohorts.

CONCLUSIONS

LPND without nCRT is effective and sufficient in preventing local recurrence in patients with LPN metastases. Future prospective randomized controlled studies are warranted to confirm these findings. Since systemic metastasis is the predominant recurrence pattern in patients with LPN metastasis post-LPND, improved perioperative systemic chemotherapy is needed to prevent micrometastasis.

摘要

目的

新辅助放化疗（nCRT）后选择性行侧方盆腔淋巴结（LPN）清扫术（LPND）已被广泛认可。本研究旨在确定 nCRT 对接受直肠全直肠系膜切除术和 LPND 的有临床 LPN 转移的直肠癌患者局部控制和预后的影响。

材料与方法

从 2012 年 1 月至 2019 年 12 月，三家机构的前瞻性数据库中检索到接受直肠侧方 LPN 转移的直肠癌患者数据，这些患者接受了全直肠系膜切除术和 LPND。通过倾向评分匹配（PSM）尽量减少选择偏倚，并比较短期和临床结果。

结果

共纳入 213 例患者，分为 nCRT 组（n=97）和非 nCRT 组（n=116）。使用 PSM 确定了 83 对匹配对。在匹配队列中，nCRT 组的手术时间更长（310.6 分钟比 265.0 分钟，P=0.001），病理 LPN 转移率更低（32.5%比 48.2%，P=0.040），清扫的淋巴结更少（22 个比 25 个，P=0.018）。然而，PSM 后，两组的总体 3 年生存率（79.5%比 80.7%，P=0.922）、3 年无病生存率（66.1%比 65.5%，P=0.820）和 3 年局部无复发生存率（88.6%比 89.7%，P=0.927）相似。远处转移是总体（45/58，77.6%）和匹配（33/44，75.0%）队列中主要的复发模式。