直肠癌新辅助治疗后淋巴结检出数目对其诊断及预后的影响

【摘要】〓目的〓本研究旨在探究直肠癌患者新辅助放化疗后淋巴结数目等对其诊断及预后的影响。方法〓回顾性纳入本中心2007~2013年行新辅助放化疗联合手术切除的直肠癌患者及单行手术切除直肠癌患者信息,并分析淋巴结数目、淋巴结转移等指标同术后病理诊断及预后的相关性。结果〓共计纳入300例新辅助放化疗联合手术切除及140例单一手术切除直肠癌患者。相对于单一手术切除,新辅助放化疗可减少淋巴结获取数目(P<0.001)及阳性淋巴结数目(P=0.001);同时发现新辅助放化疗后,淋巴结数目与肿瘤缓解等具有相关性;淋巴结转移情况是预后的独立预测指标,而淋巴结数目则不是预后预测指标。结论〓新辅助放化疗后直肠癌患者较低的淋巴结计数并非意味着切除不完全或分期不足,可在一定程度反应新辅助治疗的敏感性。

Prognostic implications of the lymph node count in rectal cancer after neoadjuvant treatment

【Abstract】〓Objective〓To investigate the effect of neoadjuvant chemoradiotherapy on the number of lymph node retrieval and removal in rectal cancer surgery. Methods〓Data for patients who underwent neoadjuvant chemoradiotherapy followed by surgery for resectable rectal cancer from 2007 to 2013 were reviewed. The primary outcomes measured were the number of lymph nodes retrieved, their status, and patient survival. Results〓Of all retrievable cases, 300 patients underwent neoadjuvant chemoradiotherapy followed by surgery, and 140 patients had surgery alone. Neoadjuvant chemoradi-otherapy decreased both the number of lymph nodes retrieved 7(1-33) versus 12.5(0-44) respectively; P<0.001] and the number of positive lymph nodes 0(0-11) versus 0(0-16); P=0.001]. After neoadjuvant chemoradiotherapy, the number of retrieved lymph nodes was inversely correlated with tumor regression, and with the interval between treatment and surgery. The 5-year overall and disease-free survival rates were 86.5 and 79.1 percent respectively. After neoadjuvant therapy, lymph node status was found to be an independent predictor of survival, whereas the number of retrieved lymph nodes did not represent a prognostic factor for either overall or disease-free survival. Conclusion〓Low lymph node count after neoadjuvant chemoradiotherapy for rectal cancer does not signify an inadequate resection or understaging, but represents an increased sensitivity to the treatment.