Poor prognostic and staging value of tumor deposit in locally advanced rectal cancer with neoadjuvant chemoradiotherapy
Poor prognostic and staging value of tumor deposit in locally advanced rectal cancer with neoadjuvant chemoradiotherapy
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新辅助放化疗局部晚期直肠癌肿瘤沉积的预后和分期价值较差。
DOI：
10.1002/cam4.2034
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发表时间：
2019-04-01
期刊：
影响因子：
4
通讯作者：
Zhang, Zhen
中科院分区：
文献类型：
--
作者：
Wang, Yaqi;Zhang, Jing;Zhang, Zhen
肿瘤存款（TD）与结直肠癌生存率低有关。然而，其在局部进展期直肠癌（LARC）患者接受新辅助放化疗（neo-CRT）后的预后和分期价值存在争议。回顾性分析了495例接受neo-CRT和手术的LARC患者。采用Kaplan-Meier法和考克斯比例风险回归对所有淋巴结（LN）阴性和LN阳性患者进行单因素和多因素分析。接下来，我们使用三种方法对LN和TD的计数进行分类（oN，仅LN计数; n1 N，根据N1 c标准的计数; n2 N，LN和TD的总数），以评估TD对N分期的影响。TD阳性患者与更积极的临床病理特征。在多变量分析中，TD是所有患者总生存期（OS）、无病生存期（DFS）和局部无复发生存期的独立不良预后因素。在LN阴性患者中，TD是OS、DFS和无远处转移生存期（DMFS）的独立不良预后因素。在LN阳性患者中，TD仅在一个LN阳性患者中具有不良预后价值。根据三种N分期方法进行的三项多因素分析显示，oN不是独立的预后因素，而n1 N和n2 N与OS、DFS和DMFS的不良生存率独立相关。n2 N法优于n1 N法。TD是新CRT后LARC患者的独立预后不良因素，尤其是在不超过一个阳性LN的患者中。在进行N分期时，TD可能应被视为一个阳性LN。
Tumor deposit (TD) was associated with poor survival in colorectal cancer. However, its prognostic and staging value in locally advanced rectal cancer (LARC) patients following neoadjuvant chemoradiotherapy (neo-CRT) is controversial. Four hundred and ninety-five LARC patients following neo-CRT and surgery were retrospectively analyzed. Univariate and multivariate analyses were performed using Kaplan-Meier method and Cox proportional hazards regression in all lymph node (LN) -negative and LN-positive patients. Next, we used three methods to classify the counts of LNs and TDs (oN, only LN counts; n1N, counts according to the N1c standards; n2N, total counts of LNs and TDs) to evaluate the impact of TD on N staging. TD-positive patients were associated with more aggressive clinicopathological features. In multivariate analyses, TD was an independent poor prognostic factor of overall survival (OS), disease-free survival (DFS), and local recurrence-free survival in all patients. In LN-negative patients, TD was an independent poor prognostic factor of OS, DFS and distant metastasis-free survival (DMFS). In LN-positive patients, TD has poor prognostic value only in patients with one positive LN. Three multivariate analyses according to three N staging methods showed that oN was not an independent prognostic factor, whereas n1N and n2N were independently associated with poor survival in OS, DFS and DMFS. The n2N method seemed to be better than n1N method. TD is an independent poor prognostic factor in LARC patients following neo-CRT, especially in patients with no more than one positive LN. TD probably should be considered as one positive LN when performing N staging.