Lymph Node Metastases in Rectal Cancer After Preoperative Radiochemotherapy: Impact of Intramesorectal Distribution and Residual Micrometastatic Involvement
Lymph Node Metastases in Rectal Cancer After Preoperative Radiochemotherapy: Impact of Intramesorectal Distribution and Residual Micrometastatic Involvement
复制标题
直肠癌术前放化疗后淋巴结转移：直肠内分布和残余微转移参与的影响
DOI：
10.1097/pas.0b013e3182886ced
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
T. Liersch
中科院分区：
文献类型：
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作者：
T. Sprenger;H. Rothe;H. Becker;T. Beissbarth;K. Homayounfar;K. Gauss;J. Kitz;H. Wolff;A. Scheel;M. Ghadimi;C. Rödel;L. Conradi;T. Liersch
前言：新辅助化疗(CRT)后，病理确定的淋巴结(LN)状态是直肠癌患者最重要的预后因素。在这里，我们评估了残留的LN微转移(<；0.2厘米)和LN转移的直肠系膜内分布对预后的影响。患者和方法：在德国直肠癌试验CAO/ARO/AIO-04中，对81例接受新辅助CRT和全直肠系膜切除术的cUICC II/III直肠癌患者的手术标本进行前瞻性评估。整个直肠系膜间室石蜡包埋，显微镜下筛查。直肠系膜LN大转移和微转移的数量和分布与无病生存率(DFS)和肿瘤特异性总生存率(CS)相关。结果：共检出淋巴结2412枚，平均29.8±13.7枚。25例患者有残存的淋巴结转移(ypN+)。直肠系膜周围的转移发生率(7.7%)高于肿瘤近端的转移发生率(1.5%)，但未发现低于肿瘤平面的转移。同时受累于肿瘤近端和瘤周的患者的CS显著降低(风险比=5.4；P<；0.05)。14例PYN+患者(56%)有微转移，9例(36%)仅有微转移。与无淋巴结转移的患者相比，淋巴结大转移患者的DFS(P<；0.01)和Css(P<；0.005)降低，而残留的微转移对生存期无影响。结论：尽管残存的LN微转移发生率很高，但在本组病例中，这些微转移似乎不会对预后产生影响。微转移可能提示对CRT有反应的肿瘤具有更有利的生物学特性。LN转移的直肠系膜内分布对预后有影响，应该在进一步的研究中加以验证。
Introduction:After neoadjuvant chemoradiation (CRT), the pathologic determined lymph node (LN) status is the most important prognostic factor in rectal cancer patients. Here we assessed the prognostic impact of residual LN micrometastases (<0.2 cm) and the intramesorectal distribution of LN metastases. Patients and Methods:Surgical specimens from 81 patients with cUICC II/III rectal cancer undergoing neoadjuvant CRT and total mesorectal excision within the German Rectal Cancer Trial CAO/ARO/AIO-04 were prospectively evaluated. The entire mesorectal compartment was paraffin embedded and screened microscopically. The number and distribution of mesorectal LN macrometastases and micrometastases were correlated with disease-free (DFS) and cancer-specific overall survival (CSS). Results:A total of 2412 LNs were detected (mean 29.8±13.7). Twenty-five patients had residual LN metastases (ypN+). The incidence of metastases in the peritumoral mesorectum was higher (7.7%) than that proximal to the tumor (1.5%), whereas no metastases were identified below the tumor level. Patients with both proximal and peritumoral involvement showed a significantly reduced CSS (hazard ratio=5.4; P<0.05). Fourteen patients with ypN+ status (56%) had micrometastases, 9 patients (36%) had only micrometastatic involvement. Patients with nodal macrometastases had a reduced DFS (P<0.01) and CSS (P<0.005) as compared with ypN0 patients, whereas residual micrometastases had no influence on survival. Conclusions:Despite the high incidence of residual LN micrometastases they did not seem to have a prognostic impact in this series. Micrometastases might indicate responsive tumors to CRT with a more favorable biology. The intramesorectal distribution of LN metastases had a prognostic impact and should be validated in further studies.