Colorectal Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.
Cancer Med. 2024 Sep;13(18):e70170. doi: 10.1002/cam4.70170.
Information about the distribution characteristics and prognostic significance of lateral lymph nodes (LLNs) on primary computed tomography (CT) scan in rectal cancer patients is lacking.
Between January 2013 and December 2016, patients with pathologically proved rectal cancer and pretreatment abdominal enhanced CT in our department were screened. We firstly redivided LLNs into seven categories based on their locations. Then, the number and distribution of all measurable LLNs and the characteristics of the largest LLN in each lateral compartment were recorded. Furthermore, we investigated the long-term outcomes in patients with different LLN characteristics and LLN risk scoring.
A total of 572 patients were enrolled in this study. About 80% of patients had measurable LLNs, and most patients developed measurable LLNs in the obturator cranial compartment. Lateral local recurrence (LLR) was observed in 20 patients, which accounted for 83.3% of the local recurrence (LR). Patients with the largest LLN short-axis diameter >10 mm had a poor prognosis, which was similar to that in patients with simultaneous distant metastasis (SDM). Patients with LLN risk scoring ≥2 had a worse prognosis than those with LLN risk scoring <2, while better than those with SDM.
This study suggests that LLR is the main locoregional recurrence pattern. Most rectal cancer patients have measurable LLNs on primary CT scan. However, patients with enlarged LLNs <10 mm or LLN risk scoring <2 still have a significantly better prognosis than patients with SDM, which indicated the potential value of locoregional treatment for these LLNs.
关于直肠癌患者原发计算机断层扫描（CT）上侧方淋巴结（LLN）的分布特征和预后意义的信息尚缺乏。
本研究筛选了 2013 年 1 月至 2016 年 12 月期间在我院接受经病理证实的直肠癌和术前腹部增强 CT 检查的患者。我们首先根据位置将 LLN 重新分为 7 类。然后，记录所有可测量的 LLN 的数量和分布情况，以及每个侧方间隙中最大 LLN 的特征。此外，我们还研究了不同 LLN 特征和 LLN 风险评分患者的长期预后。
本研究共纳入 572 例患者。约 80%的患者存在可测量的 LLN，且大多数患者在闭孔颅侧间隙中存在可测量的 LLN。20 例患者出现侧方局部复发（LLR），占局部复发（LR）的 83.3%。最大 LLN 短轴直径＞10mm 的患者预后较差，与同时存在远处转移（SDM）的患者相似。LLN 风险评分≥2 的患者预后较 LLN 风险评分＜2 的患者差，但优于 SDM 患者。
本研究表明，LLR 是主要的局部区域复发模式。大多数直肠癌患者在原发 CT 扫描上存在可测量的 LLN。然而，最大 LLN＜10mm 或 LLN 风险评分＜2 的患者的预后仍明显优于 SDM 患者，这表明对这些 LLN 进行局部区域治疗具有潜在价值。
