Huang Fei, Wei Ran, Zhou Sicheng, Mei Shiwen, Xiao Tixian, Xing Wei, Liu Qian
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, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
Discov Oncol. 2024 Nov 4;15(1):618. doi: 10.1007/s12672-024-01500-4.
Lateral lymph node dissection (LLND) can decrease local recurrence to lateral compartments in middle-low rectal cancer, but pathological evidence for optimal surgical indications, especially after neoadjuvant (chemo)radiotherapy (nCRT), is lacking. This study aimed to identify the predictive factors and oncological outcomes for different LLN locations associated with pathological metastasis.
In this multicenter study, patients from 19 centers who underwent total mesorectal excision (TME) with LLND for locally advanced mid-/low rectal cancer from January 2012 to December 2021 were included.
All 566 included patients underwent TME with LLND surgery; 241 (37.4%) of the largest LLNs were located in the obturator area, and 403 (62.6%) of the largest LLNs were located in the internal iliac area. Multivariate analysis revealed that a short-axis size of 9 mm for the obturator area and 6 mm for internal iliac nodes constituted a reliable indicator of pathological LLN metastasis in non-CRT patients. In nCRT patients, a short-axis node size of 7 mm for obturator nodes and 4 mm for internal iliac nodes could be used to accurately predict pathological LLN metastasis. In contrast to pathological internal iliac node metastasis, pathological obturator node metastasis was associated with lower distant metastasis-free survival (DMFS) (P = 0.001), cancer-specific survival (CSS) (P = 0.043), and overall survival (OS) (P = 0.009), but lower lateral local recurrence-free survival (LRFS) (P > 0.05) was not statistically significant.
The obturator and internal iliac nodes may be two completely different types of LLNs, and the optimal cutoff value for predicting pathological LLN metastasis is inconsistent regardless of nCRT. Clinical trial registration The protocol of the current study was registered on ClinicalTrials.gov (NCT04850027), and the protocols were in accordance with the standards set by the World Medical Association Declaration of Helsinki.
侧方淋巴结清扫术（LLND）可降低中低位直肠癌侧方区域的局部复发率，但缺乏关于最佳手术指征的病理证据，尤其是在新辅助（化疗）放疗（nCRT）后。本研究旨在确定与病理转移相关的不同侧方淋巴结位置的预测因素及肿瘤学结局。
在这项多中心研究中，纳入了2012年1月至2021年12月期间在19个中心接受全直肠系膜切除术（TME）联合LLND治疗局部进展期 mid-/低位直肠癌的患者。
纳入的566例患者均接受了TME联合LLND手术；最大侧方淋巴结中241个（37.4%）位于闭孔区，403个（62.6%）位于髂内区。多因素分析显示，在未接受CRT的患者中，闭孔区短轴径9 mm、髂内淋巴结短轴径6 mm是病理侧方淋巴结转移的可靠指标。在接受nCRT的患者中，闭孔淋巴结短轴径7 mm、髂内淋巴结短轴径4 mm可用于准确预测病理侧方淋巴结转移。与病理髂内淋巴结转移相比，病理闭孔淋巴结转移与更低的无远处转移生存期（DMFS）（P = 0.001）、癌症特异性生存期（CSS）（P = 0.043）和总生存期（OS）（P = 0.009）相关，但更低的侧方局部无复发生存期（LRFS）（P > 0.05）无统计学意义。
闭孔淋巴结和髂内淋巴结可能是两种完全不同类型的侧方淋巴结，无论是否接受nCRT，预测病理侧方淋巴结转移的最佳截断值均不一致。临床试验注册 本研究方案已在ClinicalTrials.gov（NCT04850027）注册，方案符合世界医学协会《赫尔辛基宣言》制定的标准。
