Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo, 154-8532, Japan.
Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, 43-1 Kamadai, Hodogaya, Yokohama, Kanagawa, Japan.
Int J Clin Oncol. 2024 Dec;29(12):1896-1907. doi: 10.1007/s10147-024-02630-z. Epub 2024 Oct 14.
Lateral node metastasis confers a poor prognosis in rectal cancer. Several multidisciplinary treatments have been proposed with favorable outcomes. However, appropriate neoadjuvant/adjuvant treatments or follow-up plans based on information about the probable recurrence site have not been specified. We aimed to clarify the distinctive features of recurrence patterns for lateral node-positive low rectal cancer according to the lateral and mesorectal lymph node status.
We retrospectively analyzed 508 patients with stage III low rectal cancer who underwent lateral node dissection. We investigated the impact of lateral and mesorectal lymph node status on site-specific recurrence rates and patient survival.
Analyses for relapse-free survival revealed the prognostic impact of lateral node positivity in stage III low rectal cancer (p < 0.0001). Lateral node-positive patients exhibited higher risk of overall recurrence, local recurrence, and recurrence in extra-regional nodes than lateral node-negative patients (p < 0.0001, p = 0.001, and p < 0.0001, respectively). However, lateral node positivity was not statistically associated with a hematogenous recurrence rate. In lateral node-positive patients, both tumor-node-metastasis (TNM)-N status and number of lateral nodes involved were revealed as significant prognostic factors (p < 0.0001, both). In addition, the number of lateral nodes involved could be a discriminatory indicator of probabilities of local recurrence and recurrence in extra-regional nodes (p = 0.02, and p < 0.0001, respectively).
Lateral node-positive low rectal cancer exhibits higher local recurrence and extra-regional node recurrence rates that correlate with the number of lateral nodes involved.
直肠癌侧方淋巴结转移预示着不良的预后。已经提出了几种多学科治疗方法，效果良好。然而，尚未根据可能的复发部位的信息确定适当的新辅助/辅助治疗或随访计划。我们旨在根据侧方和直肠系膜淋巴结状态，明确侧方淋巴结阳性低位直肠癌的复发模式特征。
我们回顾性分析了 508 例接受侧方淋巴结清扫术的 III 期低位直肠癌患者。我们研究了侧方和直肠系膜淋巴结状态对特定部位复发率和患者生存的影响。
无复发生存率分析显示，III 期低位直肠癌的侧方淋巴结阳性具有预后影响（p<0.0001）。侧方淋巴结阳性患者的总复发、局部复发和远处淋巴结复发风险高于侧方淋巴结阴性患者（p<0.0001、p=0.001 和 p<0.0001，分别）。然而，侧方淋巴结阳性与血行转移率无统计学关联。在侧方淋巴结阳性患者中，肿瘤-淋巴结-转移（TNM）-N 分期和侧方淋巴结受累数目均为显著的预后因素（p<0.0001，均）。此外，侧方淋巴结受累数目可作为局部复发和远处淋巴结复发概率的鉴别指标（p=0.02 和 p<0.0001，分别）。
侧方淋巴结阳性低位直肠癌的局部复发和远处淋巴结复发率较高，与受累侧方淋巴结数目相关。
