Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy
Clinical implication of additional selective lateral lymph node excision in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy
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DOI：
10.1007/s00384-013-1761-2
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发表时间：
2013-12-01
影响因子：
2.8
通讯作者：
Kim, Jin Cheon
中科院分区：
文献类型：
--
作者：
Lim, Seok-Byung;Yu, Chang Sik;Kim, Jin Cheon
为确定局部进展期直肠癌患者行术前放化疗时外侧淋巴结（LLN）切除的指征和预后意义，纳入了67例连续的可疑LLN转移患者，这些患者接受了放化疗和手术，包括选择性LLN切除（82例切除）。根据LLN转移的存在对切除进行分组，并根据临床病理结果和肿瘤学结果进行比较。通过影像学测量LLN的最大短径与转移率之间的相关性进行了探讨，在32例（40.0%）切除中发现LLN转移。计算的预测转移的短轴LLN直径为11.7 mm（放化疗前）和11.4 mm（手术前）。LLN转移在低位直肠中更常见（p = 0.031），并与较高的CEA水平相关（p = 0.048）。有和无LLN转移的患者的3年总生存率分别为60.3%和90.3%（p = 0.048），而3年无病生存率分别为31.4%和70.5%（p = 0.009）。LLN转移对直肠癌术后复发的危险比为2.938（95%CI = 1.258-6.863），LLN转移是直肠癌术后放化疗的不良预后因素。基于影像学研究的选择性LLN切除可能对此类患者有作用。
To identify the indication and prognostic significance of lateral lymph node (LLN) excision in locally advanced rectal cancer patients underwent preoperative chemoradiotherapy.Included were 67 consecutive patients with suspicious LLN metastasis who underwent chemoradiotherapy and surgery including selective LLN excision (82 excisions). The excisions were grouped according to the presence of LLN metastasis and compared in terms of the clinicopathological findings and oncological results. The correlation between the largest short-axis diameter of LLN measured by imaging and metastasis rates was explored.LLN metastases were identified in 32 excisions (40.0 %). The calculated short-axis LLN diameter predicting metastasis was 11.7 mm (before chemoradiotherapy) and 11.4 mm (before surgery). LLN metastasis was observed more frequently in the low rectum (p = 0.031) and associated with higher CEA levels (p = 0.048). The 3-year overall survival rates for patients with and without LLN metastasis were 60.3 % and 90.3 % (p = 0.048), while the 3-year disease-free survival rates were 31.4 % and 70.5 % (p = 0.009). The hazard ratio of LLN metastasis for recurrence was 2.938 (95 % CI = 1.258-6.863).LLN metastasis in rectal cancer patients underwent chemoradiotherapy was a distinct poor prognostic factor. Selective LLN excision based on imaging studies may have a role for such patients.