Oncological Outcomes of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated With Preoperative Chemoradiotherapy
Oncological Outcomes of Lateral Pelvic Lymph Node Metastasis in Rectal Cancer Treated With Preoperative Chemoradiotherapy
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DOI：
10.1097/dcr.0000000000000752
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发表时间：
2017-05-01
影响因子：
3.9
通讯作者：
Watanabe, Toshiaki
中科院分区：
文献类型：
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作者：
Ishihara, Soichiro;Kawai, Kazushige;Watanabe, Toshiaki
背景技术背景：直肠癌盆腔外侧淋巴结转移术前放化疗的肿瘤学结局仍有待阐明目的：本研究的目的是阐明放化疗对盆腔外侧淋巴结转移的治疗效果、盆腔外侧淋巴结转移的危险因素以及放化疗后盆腔外侧淋巴结清扫的肿瘤学结局。设计：这是一项非随机、回顾性研究。设置：研究在三级转诊大学医院进行。患者：2003年至2015年接受放化疗和根治性手术治疗的直肠癌患者（N = 222）。干预：给予放疗（共50.4戈伊，分28次），同时给予基于氟尿嘧啶的化疗。结果：31例（14.0%）患者行盆腔外侧淋巴结清扫术，其中16例（51.6%）患者病理诊断为盆腔外侧淋巴结转移。在仅行全直肠系膜切除术的患者中（n = 191），2例（0.9%）盆腔外侧淋巴结区域复发，经挽救性R 0切除术后病理证实。盆腔外侧淋巴结阴性患者的T分期降低（73.3% vs 12.5%; p < 0.01）和原发灶高度组织学消退（73.3% vs 18.8%; p < 0.01）比盆腔外侧淋巴结阳性患者更常见。年龄小，距离肛缘短，扩大的盆腔外侧淋巴结放化疗前与盆腔外侧淋巴结transferation. LIMITED：这项研究是有限的，其回顾性的性质和小的研究population.CONCLUSIONS：盆腔外侧淋巴结转移的发病率放化疗后估计为8.1%（18/222）。年龄小、距肛缘近、放化疗前盆腔外侧淋巴结肿大是放化疗后盆腔外侧淋巴结转移的危险因素。
BACKGROUND: Oncological outcomes of lateral pelvic lymph node metastasis in rectal cancer treated with preoperative chemoradiotherapy remain to be elucidated.OBJECTIVE: The purpose of this study was to clarify the therapeutic effect of chemoradiotherapy on lateral pelvic lymph node metastasis, the risk factors of lateral pelvic lymph node metastasis, and oncological outcomes of lateral pelvic lymph node dissection after chemoradiotherapy.DESIGN: This was a nonrandomized, retrospective study.SETTINGS: The study was conducted at a tertiary referral university hospital.PATIENTS: Patients with rectal cancer treated with chemoradiotherapy and radical surgery from 2003 to 2015 (N = 222) were included.INTERVENTIONS: Radiation (total, 50.4 Gy in 28 fractions) with concomitant fluorouracil-based chemotherapy was administered. Lateral pelvic lymph nodes with a diameter of >= 8 mm before chemoradiotherapy were selectively dissected.MAIN OUTCOME MEASURES: Frequency and risk factors of lateral pelvic lymph node metastasis were examined.RESULTS: Lateral pelvic lymph node dissection was performed in 31 patients (14.0%), and 16 (51.6%) of these patients were pathologically diagnosed as positive for metastasis. Among the patients treated with total mesorectal excision alone (n = 191), 2 (0.9%) had recurrence in the lateral pelvic lymph node area, which was pathologically confirmed after salvage R0 resection. T category downstaging (73.3% vs 12.5%; p < 0.01) and high histological regression of the primary lesion (73.3% vs 18.8%; p < 0.01) were more frequent in patients with pathologically negative lateral pelvic lymph nodes than in those with positive lateral pelvic lymph nodes. Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were associated with lateral pelvic lymph node metastasis.LIMITATIONS: The study was limited by its retrospective nature and small study population.CONCLUSIONS: The incidence of lateral pelvic lymph node metastasis after chemoradiotherapy was estimated to be 8.1% (18/222). Young age, short distance from the anal verge, and enlarged lateral pelvic lymph node before chemoradiotherapy were risk factors of lateral pelvic lymph node metastasis after chemoradiotherapy.