Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma.
Number of lymph nodes examined and prognosis among pathologically lymph node-negative patients after preoperative chemoradiation therapy for rectal adenocarcinoma.
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DOI：
10.1002/cncr.25973
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发表时间：
2011-08-15
期刊：
影响因子：
6.2
通讯作者：
Das, Prajnan
中科院分区：
文献类型：
--
作者：
Tsai, Chiaojung Jillian;Crane, Christopher H.;Skibber, John M.;Rodriguez-Bigas, Miguel A.;Chang, George J.;Feig, Barry W.;Eng, Cathy;Krishnan, Sunil;Maru, Dipen M.;Das, Prajnan
直肠癌术前放化疗可减少可评估淋巴结的数量。因此，淋巴结评估在直肠癌患者术前放化疗中的预后作用尚不清楚。本报告的作者根据术前放化疗后淋巴结阴性的直肠癌患者的病理范围（ypN0）评估了淋巴结检查数量对预后的影响。1990年至2004年间，372例非转移性直肠腺癌患者术前接受了放化疗，随后进行了肠系膜切除术，并患有ypN0疾病。中位放射剂量为45灰色，68%的患者接受了辅助化疗。术前放化疗后平均检查7个淋巴结。与检查≤7个淋巴结的患者相比，检查≤7个淋巴结的患者具有更高的5年无复发率（86% vs 72%; log-rank P = 0.005）和癌症特异性生存率（95% vs 86%; log-rank P = 0.004），但总体生存率无显著差异（87% vs 81%; log-rank P = 0.07）。多变量Cox比例模型显示，与检查≤7个淋巴结的患者相比，检查≤7个淋巴结的患者复发风险（风险比[HR]， 0.39; P = 0.003）和直肠癌死亡风险（风险比[HR]， 0.45; P = 0.04）显著降低，但全因死亡率风险相似（风险比，0.75;95% CI, 0.46-1.20; P = 0.23）。在接受术前放化疗后患有ypN0疾病的直肠癌患者中，检查的淋巴结数量与疾病复发和癌症特异性生存独立相关。因此，作者得出结论，检查阴性淋巴结的数量可能是接受术前放化疗的直肠癌患者的预后因素。
Preoperative chemoradiation for rectal cancer can decrease the number of evaluable lymph nodes. Hence, the prognostic role of lymph node evaluation in patients with rectal cancer who receive preoperative chemoradiation is unclear. The authors of this report evaluated the prognostic impact of the number of lymph nodes examined in patients with rectal cancer who had negative lymph nodes based on the pathologic extent of disease (ypN0) after they received preoperative chemoradiation. Between 1990 and 2004, 372 patients with nonmetastatic rectal adenocarcinoma received preoperative chemoradiation followed by mesorectal excision and had ypN0 disease. The median radiation dose was 45 gray, and 68% of patients received adjuvant chemotherapy. Patients had a median of 7 lymph nodes examined after preoperative chemoradiation. Compared with patients who had ≤7 lymph nodes examined, patients who had >7 lymph nodes had higher 5-year rates of freedom from relapse (86% vs 72%; log-rank P = .005) and cancer-specific survival (95% vs 86%; log-rank P = .0004), but no significant difference was observed in the overall survival rate (87% vs 81%; log-rank P = .07). Multivariate Cox proportional models demonstrated that patients who had >7 lymph nodes examined had a significantly lower risk of relapse (hazard ratio [HR], 0.39; P = .003) and death from rectal cancer (HR, 0.45; P = .04) but a similar risk of all-cause mortality (HR, 0.75; 95% CI, 0.46–1.20; P = .23) compared with patients who had ≤7 lymph nodes examined. The number of lymph nodes examined was associated independently with disease relapse and cancer-specific survival in patients with rectal cancer who had ypN0 disease after receiving preoperative chemoradiation. Hence, the authors concluded that the number of negative lymph nodes examined may be a prognostic factor in patients with rectal cancer who receive preoperative chemoradiation.
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