Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer
Correlations between the Recurrence Patterns and Sizes of Lateral Pelvic Lymph Nodes before and after Chemoradiotherapy in Patients with Lower Rectal Cancer
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DOI：
10.1159/000492493
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发表时间：
2019-01-01
期刊：
影响因子：
3.5
通讯作者：
Nozawa, Hiroaki
中科院分区：
文献类型：
--
作者：
Shiratori, Hiroshi;Kawai, Kazushige;Nozawa, Hiroaki
目的：预测直肠癌肺部转移的因素仍不清楚。我们研究了放化疗（CRT）前后盆腔外侧淋巴结（LPN）大小是否与下位直肠癌术后肺转移相关。方法：对 2003 年至 2017 年间接受术前 CRT 和根治性手术的 240 例下位直肠癌患者进行检查。 CRT 前后计算机断层扫描测量的 LPN 大小由 1 名不了解患者临床和病理结果的结直肠外科医生回顾性确定。结果：5年累计肺转移率为15.2%。发生肺转移的患者的平均 LPN 大小大于未发生肺转移的患者（CRT 前：8.7 毫米 vs. 6.3 毫米，p = 0.003；CRT 后：6.8 毫米 vs. 4.5 毫米，p = 0.001）。在CRT前后，大LPN患者的累积肺转移率均高于小LPN患者。在多变量分析中，肺转移仅与 CRT 后的 LPN 大小独立相关（风险比 [HR]：5.58），以及 ypT 分期（HR：2.96）和肿瘤位置（HR：0.38）。结论：CRT 后的 LPN 大小强烈预测下位直肠癌患者术后肺转移。 (C) 2018 S. Karger AG，巴塞尔
Objective: Factors that predict rectal cancer metastasis to the lungs remain undefined. We investigated whether the lateral pelvic lymph node (LPN) sizes before and after chemoradiotherapy (CRT) correlate with lung metastasis after surgery for lower rectal cancer. Methods: Two hundred and forty patients with lower rectal cancer who received preoperative CRT and curative surgery between 2003 and 2017 were examined. Computed tomography-measured LPN sizes before and after CRT were retrospectively determined by 1 colorectal surgeon who was blinded to the patients' clinical and pathological outcomes. Results: The 5-year cumulative lung metastasis rates were 15.2%. The mean LPN sizes in patients who developed lung metastasis were larger than those in patients who did not (pre-CRT: 8.7 vs. 6.3 mm, p = 0.003; post-CRT: 6.8 vs. 4.5 mm, p = 0.001). The cumulative lung metastasis rate in patients with large LPNs was higher than in those with small LPNs both before and after CRT. On multivariate analysis, lung metastasis was independently correlated with the LPN size only after CRT (hazard ratio [HR]: 5.58), together with the ypT stage (HR: 2.96) and the tumor location (HR: 0.38). Conclusions: LPN size after CRT is strongly predictive of postoperative lung metastasis in patients with lower rectal cancer. (C) 2018 S. Karger AG, Basel