Ito Sono, Takamizawa Yasuyuki, Moritani Konosuke, Tsukamoto Shunsuke, Kanemitsu Yukihide
Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.
J Anus Rectum Colon. 2024 Oct 25;8(4):393-402. doi: 10.23922/jarc.2024-041. eCollection 2024.
Some patients with lower rectal cancer develop "skip metastasis," in which lymph node metastasis occurs in the lateral but not the mesenteric lymph nodes. However, the prognostic impact of skip metastasis is unclear. This study aimed to determine the long-term prognosis of skip metastasis in lower rectal cancer.
This retrospective study included patients with stage I-III lower rectal cancer who underwent total mesorectal excision and lateral lymph node dissection at our institution between 2000 and 2019. We investigated the association of lymph node metastasis with relapse-free and overall survival. Multivariate analyses were performed using Cox proportional hazards regression models.
Of a total of 371 patients, 183 (49%) were negative for lymph node metastasis, 115 (31%) were positive for mesenteric lymph nodes only, 18 (5%) were positive for lateral lymph nodes only (skip metastasis), and 55 (15%) were positive for both mesenteric and lateral lymph nodes; the 5-year relapse-free survival rates were respectively 79.9%, 60.0%, 68.3%, and 32.7%, and 5-year overall survival rates were 96.6%, 90.0%, 85.6%, and 57.3%. Multivariable analysis revealed significant differences in relapse-free and overall survival between those positive for both mesenteric and lateral lymph nodes and those positive for lateral lymph nodes only (relapse-free survival, hazard ratio 2.30, p=0.048; overall survival, hazard ratio 3.50, p=0.030).
In patients with lower rectal cancer who underwent total mesorectal excision and lateral lymph node dissection, those with skip metastasis had better relapse-free and overall survival than those with both mesenteric and lateral lymph node metastases.
一些低位直肠癌患者会发生“跳跃转移”，即侧方淋巴结而非肠系膜淋巴结发生转移。然而，跳跃转移对预后的影响尚不清楚。本研究旨在确定低位直肠癌跳跃转移的长期预后。
这项回顾性研究纳入了2000年至2019年间在本机构接受全直肠系膜切除术和侧方淋巴结清扫术的I-III期低位直肠癌患者。我们调查了淋巴结转移与无复发生存率和总生存率之间的关联。使用Cox比例风险回归模型进行多变量分析。
在总共371例患者中，183例（49%）淋巴结转移阴性，115例（31%）仅肠系膜淋巴结阳性，18例（5%）仅侧方淋巴结阳性（跳跃转移），55例（15%）肠系膜和侧方淋巴结均阳性；5年无复发生存率分别为79.9%、60.0%、68.3%和32.7%，5年总生存率分别为96.6%、90.0%、85.6%和57.3%。多变量分析显示，肠系膜和侧方淋巴结均阳性的患者与仅侧方淋巴结阳性的患者在无复发生存率和总生存率方面存在显著差异（无复发生存率，风险比2.30，p = 0.048；总生存率，风险比3.50，p = 0.030）。
在接受全直肠系膜切除术和侧方淋巴结清扫术的低位直肠癌患者中，发生跳跃转移的患者比肠系膜和侧方淋巴结均发生转移的患者具有更好的无复发生存率和总生存率。
