摘要
目的探讨临床怀疑侧方淋巴结(LPN)肿大的中低位直肠癌患者,新辅助放化疗(nCRT)后行选择性侧方淋巴结清扫术(LPND)的指征与生存获益。方法回顾性分析2015年1月至2021年1月73例临床怀疑LPN转移并在nCRT后行全直肠系膜切除术(TME)联合LPND患者的临床资料,根据术后病理结果分为LPN阳性组(n=15例)与LPN阴性组(n=58例)。数据采用统计学软件SPSS24.0分析,采用多因素Logistic回归分析与LPN转移相关的变量。采用Kaplan-Meier绘制生存曲线,并通过Log-Rank检验进行生存分析比较。P<0.05为差异有统计学意义。结果果术后病理LPN阳性率为20.5%(15/73)。多因素分析显示nCRT后LPN短径≥7mm(OR=49.65,95%CI:3.98-619.1,P=0.002)和脉管瘤栓(OR=9.23,95%CI:1.28-66.35,P=0.027)是nCRT后LPN转移的危险因素。LPN阳性患者术后3年局部复发率与LPN阴性患者(13.3%vs.6.9%,P=0.596)相似,但3年远处转移率(53.3%us.24.4%,P=0.027)仍较高。LPN阳性患者术后3年总生存期(OS)与无病生存期(DFS)显著低于LPN阴性患者。结论nCRT后LPN短径≥7mm与脉管瘤栓是nCRT后LPN转移的危险因素。虽然LPN转移患者通过nCRT联合LPND达到较好的局部控制效果,但术后远处转移率高、预后仍较差.
Objective To investigate the indications and survival benefits of selective lateral lymph node dissection(LPND)after neoadjuvant chemoradiotherapy(nCRT)in patients with middle and low rectal cancer suspected of lateral lymph node(LPN)enlargement.MethodsThe clinical data of 73 patients with suspected LPN metastasis who underwent total mesenteric resection(TME)combined with LPND after nCRT from January 2015 to January 2021 were retrospectively analyzed.According to postoperative pathological results,they were divided into LPN positive group(n=15 cases)and LPN negative group(n=58 cases).Statistical software SPSS 24.0 was used to analyze the data,and multivariate Logistic regression was used to analyze the variables related to LPN transfer.Survival curve was drawn by Kaplan-Meier,and survival analysis was compared by Log-Rank.P<0.05 was considered statistically significant.Results The positive rate of postoperative pathological LPN was 20.5%(15/73).Multivariate analysis showed that the short diameter of LPN≥7 mm(OR=49.65,95%CI:3.98-619.1,P=0.002)and thrombus of angioma(OR=9.23,95%CI:1.28-66.35,P-0.027)after nCRT were risk factors for LPN metastasis.The 3-year local recurrence rate of LPN-positive patients was similar to that of LPN-negative patients(13.3%us.6.9%,P=0.596),but the 3-year distant metastasis rate(53.3%us.24.4%,P=0.027)was still higher.The 3-year overall survival(OS)and disease-free survival(DFS)of LPN-positive patients were significantly lower than those of LPN-negative patients.Conclusion The short diameter of LPN≥7 mm after nCRT and the thrombus of vasculature are the risk factors of LPN metastasis after nCRT.Although patients with LPN metastasis can achieve better local control effect by combining nCRT with LPND,the rate of distant metastasis after surgery is high and the prognosis is still poor.
作者
达热拜·热达提
刘林
赵为民
孟涛
雷程
金博
毕建军
李新宇
王海江
DaRebai·ReDati;Liu Lin;Zhao Weimin;Meng Tao;Lei Cheng;Jin Bo;Bi Jianjun;Li Xinyu;Wang Haijiang(Department of Gastrointestinal Surgery,The Affiliated Cancer Hospital of Xinjiang Medical University,Xinjiang Urumqi Auonomous Region 83001l,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华普外科手术学杂志（电子版）》
2024年第4期415-418,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
中国癌症基金会北京希望马拉松专项基金(LC2019A30)。
关键词
直肠肿瘤
淋巴转移
新辅助放化疗
淋巴结切除术
复发
预后
Rectal Neoplasms
Lymphatic Metastasis
Neoadjuvant Chemoradiotherapy
Lymph Node Excision
Recurrence
Prognosis
