侧方局部复发直肠癌中侧方淋巴结大小和恶性特征在风险分层中的价值：一项全国性队列研究。

Value of Size and Malignant Features of Lateral Lymph Nodes in Risk Stratification at Lateral Local Recurrence of Rectal Cancer: A National Cohort Study.

机构信息

Department of Surgery, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.

Cancer Center Amsterdam, Treatment and Quality of Life, Imaging and Biomarkers, Amsterdam, the Netherlands.

出版信息

J Natl Compr Canc Netw. 2024 Feb;22(1):17-25. doi: 10.6004/jnccn.2023.7081.

DOI:10.6004/jnccn.2023.7081

PMID:38394768

Abstract

BACKGROUND

Patients with rectal cancer who have enlarged lateral lymph nodes (LLNs) have an increased risk of lateral local recurrence (LLR). However, little is known about prognostic implications of malignant features (internal heterogeneity, irregular margins, loss of fatty hilum, and round shape) on MRI and number of enlarged LLNs, in addition to LLN size.

METHODS

Of the 3,057 patients with rectal cancer included in this national, retrospective, cross-sectional cohort study, 284 with a cT3-4 tumor located ≤8 cm from the anorectal junction who received neoadjuvant treatment and who had visible LLNs on MRI were selected. Imaging was reassessed by trained radiologists. LLNs were categorized based on size. Influence of malignant features and the number of LLNs on LLR was investigated.

RESULTS

Of 284 patients with at least 1 visible LLN, 122 (43%) had an enlarged node (≥7.0 mm) and 157 (55%) had malignant features. Of the 122 patients with enlarged nodes, 25 had multiple (≥2). In patients with a single enlarged node (n=97), a single malignant feature was associated with a 4-year LLR rate of 0% and multiple malignant features was associated with a rate of 17% (P=.060). In the group with multiple malignant features, their disappearance on restaging was associated with an LLR rate of 13% compared with an LLR rate of 20% for persistent malignant features (P=.532). The presence of intermediate-size LLNs (5.0-6.9 mm) with at least 1 malignant feature was associated with a 4-year LLR rate of 8%; the 4-year LLR rate was 13% when the malignant features persisted on restaging MRI (P=.409). Patients with multiple enlarged LLNs had a 4-year LLR rate of 28% compared with 11% for those with a single enlarged LLN (P=.059).

CONCLUSIONS

The presence of multiple enlarged LLNs (≥7.0 mm), as well as multiple malignant features in an enlarged node contribute to the risk of developing an LLR. These radiologic features can be used for clinical decision-making regarding the potential benefit of LLN dissection.

摘要

背景

侧方淋巴结（LLN）肿大的直肠癌患者发生侧方局部复发（LLR）的风险增加。然而，关于 MRI 上恶性特征（内部异质性、不规则边界、脂肪门消失和圆形）以及肿大的 LLN 数量对预后的影响，除了 LLN 大小外，我们知之甚少。

方法

在这项全国性、回顾性、横断面队列研究中，纳入了 3057 例位于距肛门直肠交界处≤8cm 的 cT3-4 期直肠癌患者，这些患者接受了新辅助治疗，并且 MRI 上可见 LLN。由经过培训的放射科医生重新评估影像学结果。根据大小对 LLN 进行分类。研究了恶性特征和 LLN 数量对 LLR 的影响。

结果

在 284 例至少有 1 个可见 LLN 的患者中，122 例（43%）的淋巴结肿大（≥7.0mm），157 例（55%）存在恶性特征。在 122 例淋巴结肿大的患者中，25 例存在多个（≥2 个）淋巴结肿大。在有单个肿大淋巴结（n=97）的患者中，单个恶性特征与 4 年 LLR 发生率为 0%相关，而多个恶性特征与 17%的 LLR 发生率（P=.060）相关。在具有多个恶性特征的组中，其在重新分期时消失与 LLR 发生率为 13%相关，而持续存在恶性特征的 LLR 发生率为 20%（P=.532）。存在至少 1 个恶性特征的中等大小 LLN（5.0-6.9mm）与 4 年 LLR 发生率为 8%相关，而在重新分期 MRI 上恶性特征持续存在时，4 年 LLR 发生率为 13%（P=.409）。与单个淋巴结肿大相比，多个淋巴结肿大患者的 4 年 LLR 发生率为 28%，而单个淋巴结肿大患者的 4 年 LLR 发生率为 11%（P=.059）。