局部进展期中低位直肠癌新辅助治疗对淋巴结检出数目的影响及预后分析_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

孙祺 ¹ , 刘畅 ¹ , 邬君义 ¹ , 黄文博 ¹ , 周华友 ² , 孙学军 ¹ ,  赵伟 ¹

1. ;
2. ;

Corresponding author：

赵伟, Email: zhaowei9803@126.com

Keywords：

直肠癌; 新辅助治疗; 淋巴结检出数目; 预后

DOI：

10.7507/1007-9424.202312076

Video：

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目的分析接受新辅助治疗的局部进展期中低位直肠癌患者在根治性切除术中可能影响淋巴结检出数目的因素，并分析淋巴结检出数目对预后的影响。方法回顾性分析2016年3月至2021年12月期间西安交通大学第一附属医院收治且接受新辅助治疗联合根治性手术的局部进展期中低位直肠癌患者的临床病理资料，采用线性回归模型筛选影响淋巴结检出数目的因素，Kaplan-Meier法绘制生存曲线。结果共收集到81例局部进展期中低位直肠癌根治性切除术患者，淋巴结检出数目（12.11±5.54）枚/例；检出淋巴结平均数目＜12枚者42例、≥12枚者39例。多因素线性回归模型分析结果发现，男性患者和联合新辅助放疗降低检出淋巴结数目的概率（分别为：t=–3.17，P=0.002；t=–2.44，P=0.017）。以检出淋巴结平均数目12枚为截点分析＜12枚和≥12枚患者的Kaplan-Meier法绘制的生存曲线，经log-rank检验发现，检出淋巴结平均数目＜12枚和≥12枚患者的总生存和无病生存曲线比较差异均无统计学意义（分别为：χ²=0.107，P=0.743；χ²=0.027，P=0.87）。对64例临床区域淋巴结阳性患者分别以淋巴结检出数目平均6～13枚（＜6/≥6；……；＜13/≥13）作为分组截点进行分层分析的结果发现，以平均7枚和8枚淋巴结检出数目作为分组截点的2组患者的累积总生存情况比较差异有统计学意义（χ²=3.98，P=0.046），即检出淋巴结平均数目超过7或8枚者的总生存情况更好。结论从本研究的数据分析结果提示，对于男性患者和联合了新辅助放疗的患者术后获检淋巴结数目会有一定的影响，从总体患者的生存分析看，未发现检出淋巴结数目与总生存和复发有关，但在临床区域淋巴结阳性的患者中发现，至少检出7枚淋巴结可以提高预后。

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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.	刘昕, 马洁, 刘骞, 等. 腹腔镜直肠癌根治术的淋巴结检出数目影响因素分析. 中华肿瘤杂志, 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.	陈成辉, 程少文, 王石坚. 低位直肠癌新辅助治疗后淋巴结检出数目与预后的关系研究. 结直肠肛门外科, 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. 中华人民共和国国家卫生健康委员会. 中国结直肠癌诊疗规范(2020年版). 中华外科杂志, 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. 刘昕, 马洁, 刘骞, 等. 腹腔镜直肠癌根治术的淋巴结检出数目影响因素分析. 中华肿瘤杂志, 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. 陈成辉, 程少文, 王石坚. 低位直肠癌新辅助治疗后淋巴结检出数目与预后的关系研究. 结直肠肛门外科, 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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