Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae118.
The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival.
This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored.
Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively).
In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.
目前，腹膜外局部晚期直肠癌的金标准是新辅助全程放化疗（TNT）后行全直肠系膜切除术。本研究探讨了 TNT 后局部晚期直肠癌患者的淋巴结数量及其与生存的关系。
这是一项基于 STELLAR 试验的事后分析，纳入了 2015 年至 2018 年期间来自 16 个三级中心的局部晚期直肠癌患者，他们被随机分为短期放疗后化疗（TNT 组）或长期同期放化疗后全直肠系膜切除术组。本淋巴结相关分析基于 TNT 组。根据淋巴结清扫（低于中位数：有限淋巴结清扫组，大于/等于中位数：广泛淋巴结清扫组）对亚组进行区分。主要结局是总生存和无病生存（DFS）。探讨了与临床/病理变量、淋巴结清扫分类和辅助化疗应用的相关性。
在 STELLAR 试验中，451 例患者入组，其中 227 例（50.3%）患者被分配至 TNT 组，包括 29.5%的女性。TNT 组患者的淋巴结中位检出数为 11.0 个。有限淋巴结清扫组的总生存明显差于广泛淋巴结清扫组（HR 2.95（95%可信区间 1.47 至 5.92），P = 0.001）。ypN0-有限组和 ypN1-广泛组的总生存无显著差异（HR 0.38（95%可信区间 0.11 至 1.30），P = 0.109）。与未行辅助化疗相比，TNT 后辅助化疗总体上具有更好的总生存和 DFS（P < 0.001），在有限淋巴结清扫组中也是如此（P < 0.001）。然而，在广泛淋巴结清扫组中，辅助化疗与不辅助化疗的总生存或 DFS 无显著差异（P = 0.887 和 P = 0.192）。
在 STELLAR 试验中，淋巴结中位检出数为 11.0 个。在有限淋巴结清扫组中，TNT 后使用辅助治疗有益，与未接受辅助化疗的患者相比，其预后更好。
