Ogura Atsushi, Shiomi Akio, Yamamoto Seiichiro, Komori Koji, Hamamoto Hiroki, Manabe Shoichi, Miyakita Hiroshi, Okuda Junji, Yatsuya Hiroshi, Uehara Kay
Division of Surgical Oncology, Department of Surgery Nagoya University Graduate School of Medicine Aichi Japan.
Division of Colon and Rectal Surgery Shizuoka Cancer Center Shizuoka Japan.
Ann Gastroenterol Surg. 2023 Sep 19;8(2):284-292. doi: 10.1002/ags3.12742. eCollection 2024 Mar.
Although the oncological impact of lateral lymph node dissection on enlarged lateral lymph nodes has been gradually accepted over the last decade, that on lateral lymph nodes without swelling remains doubtful. This study aimed to develop a prediction model for the future risk of lateral local recurrence and to clarify the value of adding lateral lymph node dissection in locally advanced rectal cancer without enlarged lateral lymph nodes.
This retrospective, multi-institutional study recruited 812 patients with cStage II/III low rectal cancer without enlarged lateral lymph nodes <7 mm. Total lateral local recurrence was a hypothetical value of future risk of lateral local recurrence when lateral lymph node dissection was never performed.
Overall, total lateral local recurrences were observed in 67 patients (8.3%). In the multivariate analyses, the strongest risk factor for total local recurrences was no preoperative chemoradiotherapy (odds ratio [OR][95%Cl]: 33.2 [4.56-241.7], 0.001), followed by tumor distance ≤40 mm (OR [95%Cl]: 2.71 [1.51-4.86], 0.001) and lateral lymph node 5-7 mm (OR[95%Cl]: 2.38 [1.26-4.48], 0.007). In patients with lateral lymph nodes of 5-7 mm, the total lateral recurrence rate was 4.8% after preoperative chemoradiotherapy. Lateral lymph node dissection could reduce from a total lateral local recurrence of 21.6% to an actual lateral local recurrence of 8.0% in patients without preoperative treatment.
We introduce a novel prediction model of future risk of lateral local recurrences, which has the potential to enable us to indicate lateral lymph node dissection selectively according to the patients' risks.
尽管在过去十年中，侧方淋巴结清扫术对肿大侧方淋巴结的肿瘤学影响已逐渐被接受，但对未肿大侧方淋巴结的影响仍存在疑问。本研究旨在建立一个预测侧方局部复发未来风险的模型，并阐明在无侧方淋巴结肿大的局部晚期直肠癌中增加侧方淋巴结清扫术的价值。
这项回顾性、多机构研究纳入了812例c期II/III期低位直肠癌患者，其侧方淋巴结未肿大且直径<7mm。总侧方局部复发是指从未进行侧方淋巴结清扫术时侧方局部复发未来风险的假设值。
总体而言，67例患者（8.3%）出现了总侧方局部复发。在多因素分析中，总局部复发的最强危险因素是未进行术前放化疗（比值比[OR][95%置信区间]：33.2[4.56-241.7]，P=0.001），其次是肿瘤距肛缘≤40mm（OR[95%置信区间]：2.71[1.51-4.86]，P=0.001）和侧方淋巴结5-7mm（OR[95%置信区间]：2.38[1.26-4.48]，P=0.007）。在侧方淋巴结为5-7mm的患者中，术前放化疗后总侧方复发率为4.8%。对于未接受术前治疗的患者，侧方淋巴结清扫术可使总侧方局部复发率从21.6%降至实际侧方局部复发率8.0%。
我们引入了一种新的侧方局部复发未来风险预测模型，该模型有可能使我们能够根据患者的风险选择性地指示进行侧方淋巴结清扫术。
