局部進展期中低位直腸癌新輔助治療對淋巴結檢出數目的影響及預后分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

孫祺 ¹ , 劉暢 ¹ , 鄔君義 ¹ , 黃文博 ¹ , 周華友 ² , 孫學軍 ¹ ,  趙偉 ¹

1. ;
2. ;

Corresponding?author：

趙偉, Email: zhaowei9803@126.com

Keywords：

直腸癌; 新輔助治療; 淋巴結檢出數目; 預后

DOI：

10.7507/1007-9424.202312076

Video：

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目的分析接受新輔助治療的局部進展期中低位直腸癌患者在根治性切除術中可能影響淋巴結檢出數目的因素，并分析淋巴結檢出數目對預后的影響。方法回顧性分析2016年3月至2021年12月期間西安交通大學第一附屬醫院收治且接受新輔助治療聯合根治性手術的局部進展期中低位直腸癌患者的臨床病理資料，采用線性回歸模型篩選影響淋巴結檢出數目的因素，Kaplan-Meier法繪制生存曲線。結果共收集到81例局部進展期中低位直腸癌根治性切除術患者，淋巴結檢出數目（12.11±5.54）枚/例；檢出淋巴結平均數目＜12枚者42例、≥12枚者39例。多因素線性回歸模型分析結果顯示，男性患者和聯合新輔助放療可降低檢出淋巴結數目的概率（分別為：t=–3.17，P=0.002；t=–2.44，P=0.017）。以檢出淋巴結平均數目12枚為截點分析＜12枚和 ≥12枚患者的Kaplan-Meier法繪制的生存曲線，經log-rank檢驗發現，檢出淋巴結平均數目＜12枚和 ≥12枚患者的總生存和無病生存曲線比較差異均無統計學意義（分別為：χ²=0.107，P=0.743；χ²=0.027，P=0.870）。對64例臨床區域淋巴結陽性患者將淋巴結檢出數目平均6～13枚分別以＜6枚/≥6枚、……和＜13枚/≥13枚作為分組截點進行分層分析的結果顯示，以平均7枚和8枚淋巴結檢出數目作為分組截點的2組患者的累積總生存情況比較差異有統計學意義（χ²=3.977，P=0.046；χ²=3.977，P=0.046），即檢出淋巴結平均數目至少7枚或8枚者的總生存情況更好。結論本研究的數據分析結果提示，男性患者和聯合了新輔助放療的患者對術后獲檢淋巴結數目會有一定的影響；從總體患者的生存分析看，未發現檢出淋巴結數目與總生存和復發有關，但在臨床區域淋巴結陽性的患者中發現，至少檢出7枚或8枚淋巴結可以改善患者的預后。

Citation： 孫祺, 劉暢, 鄔君義, 黃文博, 周華友, 孫學軍, 趙偉. 局部進展期中低位直腸癌新輔助治療對淋巴結檢出數目的影響及預后分析. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(6): 739-742. doi: 10.7507/1007-9424.202312076 Copy

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2.	Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 29-42.
3.	Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons, 2011.
4.	Sobin LH. TNM classification: clarification of number of regional lymph nodes for pN0. Br J Cancer, 2001, 85(5): 780. doi: 10.1054/bjoc.2001.1996.
5.	Sun Y, Wu X, Lin H, et al. Lymph node regression to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: prognostic implication and a predictive model. J Gastrointest Surg, 2021, 25(4): 1019-1028.
6.	Wichmann MW, Müller C, Meyer G, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg, 2002, 137(2): 206-210.
7.	Mechera R, Schuster T, Rosenberg R, et al. Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: A systematic review and meta-analysis. Eur J Cancer, 2017, 72: 84-94.
8.	Latkauskas T, Lizdenis P, Janciauskiene R, et al. Lymph node retrieval after resection of rectal cancer following preoperative chemoradiotherapy. Medicina (Kaunas), 2010, 46(5): 299-304.
9.	Morcos B, Baker B, Al Masri M, et al. Lymph node yield in rectal cancer surgery: effect of preoperative chemoradiotherapy. Eur J Surg Oncol, 2010, 36(4): 345-349.
10.	Damin DC, Rosito MA, Contu PC, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg, 2012, 16(8): 1573-1580.
11.	Bustamante-Lopez L, Nahas CS, Nahas SC, et al. Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment. Int J Colorectal Dis, 2017, 32(6): 925-927.
12.	劉昕, 馬潔, 劉騫, 等. 腹腔鏡直腸癌根治術的淋巴結檢出數目影響因素分析. 中華腫瘤雜志, 2016, 38(12): 915-919.
13.	Mekenkamp LJ, van Krieken JH, Marijnen CA, et al. Lymph node retrieval in rectal cancer is dependent on many factors—the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol, 2009, 33(10): 1547-1553.
14.	Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys, 2005, 61(2): 426-431.
15.	陳成輝, 程少文, 王石堅. 低位直腸癌新輔助治療后淋巴結檢出數目與預后的關系研究. 結直腸肛門外科, 2020, 26(4): 439-443.
16.	Kim HJ, Jo JS, Lee SY, et al. Low lymph node retrieval after preoperative chemoradiation for rectal cancer is associated with improved prognosis in patients with a good tumor response. Ann Surg Oncol, 2015, 22(6): 2075-2081.
17.	Yeo CS, Syn N, Liu H, et al. A lower cut-off for lymph node harvest predicts for poorer overall survival after rectal surgery post neoadjuvant chemoradiotherapy. World J Surg Oncol, 2020, 18(1): 58. doi: 10.1186/s12957-020-01833-8.
18.	Tan L, Liu ZL, Ma Z, et al. Prognostic impact of at least 12 lymph nodes after neoadjuvant therapy in rectal cancer: a meta-analysis. World J Gastrointest Oncol, 2020, 12(12): 1443-1455.
19.	Park IJ, Yu CS, Lim SB, et al. Prognostic implications of the number of retrieved lymph nodes of patients with rectal cancer treated with preoperative chemoradiotherapy. J Gastrointest Surg, 2014, 18(10): 1845-1851.
20.	Karjol U, Jonnada P, Chandranath A, et al. Lymph node ratio as a prognostic marker in rectal cancer survival: a systematic review and meta-analysis. Cureus, 2020, 12(5): e8047. doi: 10.7759/cureus.8047.

1. 中華人民共和國國家衛生健康委員會. 中國結直腸癌診療規范(2020年版). 中華外科雜志, 2020, 58(8): 561-585.
2. Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial. Lancet Oncol, 2021, 22(1): 29-42.
3. Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. John Wiley & Sons, 2011.
4. Sobin LH. TNM classification: clarification of number of regional lymph nodes for pN0. Br J Cancer, 2001, 85(5): 780. doi: 10.1054/bjoc.2001.1996.
5. Sun Y, Wu X, Lin H, et al. Lymph node regression to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer: prognostic implication and a predictive model. J Gastrointest Surg, 2021, 25(4): 1019-1028.
6. Wichmann MW, Müller C, Meyer G, et al. Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg, 2002, 137(2): 206-210.
7. Mechera R, Schuster T, Rosenberg R, et al. Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: A systematic review and meta-analysis. Eur J Cancer, 2017, 72: 84-94.
8. Latkauskas T, Lizdenis P, Janciauskiene R, et al. Lymph node retrieval after resection of rectal cancer following preoperative chemoradiotherapy. Medicina (Kaunas), 2010, 46(5): 299-304.
9. Morcos B, Baker B, Al Masri M, et al. Lymph node yield in rectal cancer surgery: effect of preoperative chemoradiotherapy. Eur J Surg Oncol, 2010, 36(4): 345-349.
10. Damin DC, Rosito MA, Contu PC, et al. Lymph node retrieval after preoperative chemoradiotherapy for rectal cancer. J Gastrointest Surg, 2012, 16(8): 1573-1580.
11. Bustamante-Lopez L, Nahas CS, Nahas SC, et al. Understanding the factors associated with reduction in the number of lymph nodes in rectal cancer patients treated by neoadjuvant treatment. Int J Colorectal Dis, 2017, 32(6): 925-927.
12. 劉昕, 馬潔, 劉騫, 等. 腹腔鏡直腸癌根治術的淋巴結檢出數目影響因素分析. 中華腫瘤雜志, 2016, 38(12): 915-919.
13. Mekenkamp LJ, van Krieken JH, Marijnen CA, et al. Lymph node retrieval in rectal cancer is dependent on many factors—the role of the tumor, the patient, the surgeon, the radiotherapist, and the pathologist. Am J Surg Pathol, 2009, 33(10): 1547-1553.
14. Baxter NN, Morris AM, Rothenberger DA, et al. Impact of preoperative radiation for rectal cancer on subsequent lymph node evaluation: a population-based analysis. Int J Radiat Oncol Biol Phys, 2005, 61(2): 426-431.
15. 陳成輝, 程少文, 王石堅. 低位直腸癌新輔助治療后淋巴結檢出數目與預后的關系研究. 結直腸肛門外科, 2020, 26(4): 439-443.
16. Kim HJ, Jo JS, Lee SY, et al. Low lymph node retrieval after preoperative chemoradiation for rectal cancer is associated with improved prognosis in patients with a good tumor response. Ann Surg Oncol, 2015, 22(6): 2075-2081.
17. Yeo CS, Syn N, Liu H, et al. A lower cut-off for lymph node harvest predicts for poorer overall survival after rectal surgery post neoadjuvant chemoradiotherapy. World J Surg Oncol, 2020, 18(1): 58. doi: 10.1186/s12957-020-01833-8.
18. Tan L, Liu ZL, Ma Z, et al. Prognostic impact of at least 12 lymph nodes after neoadjuvant therapy in rectal cancer: a meta-analysis. World J Gastrointest Oncol, 2020, 12(12): 1443-1455.
19. Park IJ, Yu CS, Lim SB, et al. Prognostic implications of the number of retrieved lymph nodes of patients with rectal cancer treated with preoperative chemoradiotherapy. J Gastrointest Surg, 2014, 18(10): 1845-1851.
20. Karjol U, Jonnada P, Chandranath A, et al. Lymph node ratio as a prognostic marker in rectal cancer survival: a systematic review and meta-analysis. Cureus, 2020, 12(5): e8047. doi: 10.7759/cureus.8047.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

局部進展期中低位直腸癌新輔助治療對淋巴結檢出數目的影響及預后分析

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