Bhutiani Neal, Ochiai Kentaro, Awiwi Muhammad O, Rodriguez-Bigas Miguel A, Uppal Abhineet, Peacock Oliver, Messick Craig, White Michael G, Skibber John M, Bednarski Brian K, You Y Nancy, Chang George J, Kaur Harmeet, Konishi Tsuyoshi
Department of Colon and Rectal Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2024 Sep;31(9):5962-5970. doi: 10.1245/s10434-024-15539-8. Epub 2024 Jun 5.
INTRODUCTION: In colorectal cancer, the presence of para-aortic lymph nodes (PALN) indicates extraregional disease. Appropriately selecting patients for whom PALN dissection will provide oncologic benefit remains challenging. This study identified factors to predict survival among patients undergoing PALN dissection for colorectal cancer. METHODS: An institutional database was queried for patients who underwent curative-intent resection of clinically positive PALN for colorectal cancer between 2007 and 2020. Preoperative radiologic images were reviewed, and patients who did and did not have positive PALN on final pathology were compared. Survival analysis was performed to evaluate the impact of pathologically positive PALN on recurrence-free (RFS) and overall survival (OS). RESULTS: Of 74 patients who underwent PALN dissection, 51 had PALN metastasis at the time of primary tumor diagnosis, whereas 23 had metachronous PALN disease. Preoperative chemotherapy ± radiotherapy was given in 60 cases (81.1%), and 28 (37.8%) had pathologically positive PALN. Independent factors associated with positive PALN pathology included metachronous PALN disease and pretreatment and posttreatment radiographically abnormal PALN. On multivariable analysis, pathologically positive PALN was significantly associated with decreased RFS (hazard ratio 3.90) and OS (HR 4.49). Among patients with pathologically positive PALN, well/moderately differentiated histology was associated with better OS, and metachronous disease trended toward an association with better OS. CONCLUSIONS: Pathologically positive PALN are associated with poorer RFS and OS after PALN dissection for colorectal cancer. Clinicopathologic factors may predict pathologic PALN positivity. Curative-intent surgery may provide benefit, especially in patients with well-to-moderately differentiated primary tumors and possibly metachronous PALN disease.
引言：在结直肠癌中，腹主动脉旁淋巴结（PALN）的存在表明存在区域外疾病。合理选择能从PALN清扫术中获得肿瘤学益处的患者仍然具有挑战性。本研究确定了预测接受结直肠癌PALN清扫术患者生存情况的因素。 方法：查询机构数据库，找出2007年至2020年间因结直肠癌对临床阳性PALN进行根治性切除的患者。回顾术前影像学图像，比较最终病理检查PALN阳性和阴性的患者。进行生存分析，以评估病理阳性PALN对无复发生存期（RFS）和总生存期（OS）的影响。 结果：在74例行PALN清扫术的患者中，51例在原发性肿瘤诊断时已有PALN转移，而23例有异时性PALN疾病。60例（81.1%）患者接受了术前化疗±放疗，28例（37.8%）患者病理检查PALN阳性。与PALN病理阳性相关的独立因素包括异时性PALN疾病以及治疗前和治疗后影像学检查显示异常的PALN。多变量分析显示，病理阳性PALN与RFS降低（风险比3.90）和OS降低（HR 4.49）显著相关。在病理阳性PALN的患者中，组织学分级为高/中分化与较好的OS相关，异时性疾病与较好的OS有一定关联趋势。 结论：结直肠癌PALN清扫术后，病理阳性PALN与较差的RFS和OS相关。临床病理因素可预测病理PALN阳性。根治性手术可能有益，尤其是对于原发性肿瘤为高/中分化且可能有异时性PALN疾病的患者。
Int J Colorectal Dis. 2017-7
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