[1]陈 朝,柯友忠,刘 渊,等.局部进展期直肠癌新辅助放化疗术后淋巴结持续受累的临床病理因素及预后分析[J].医学信息,2022,35(17):53-56.[doi:10.3969/j.issn.1006-1959.2022.17.012]
　CHEN Chao,KE You-zhong,LIU Yuan,et al.Clinicopathological Factors and Prognostic Analysis of Persistent Lymph Node Involvement After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer[J].Journal of Medical Information,2022,35(17):53-56.[doi:10.3969/j.issn.1006-1959.2022.17.012]
点击复制

局部进展期直肠癌新辅助放化疗术后淋巴结持续受累的临床病理因素及预后分析()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年17期
页码:
53-56
栏目:
论著
出版日期:
2022-09-01

文章信息/Info

Title:
Clinicopathological Factors and Prognostic Analysis of Persistent Lymph Node Involvement After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer
文章编号:
1006-1959（2022）17-0053-04
作者:
陈 朝; 柯友忠; 刘 渊; 等
（重庆医科大学附属第一医院胃肠外科，重庆 400000）
Author(s):
CHEN Chao; KE You-zhong; LIU Yuan; et al.
(Department of Gastroenterology,First Affiliated Hospital of Chongqing Medical University,Chongqing 400000,China)
关键词:
直肠癌; 新辅助治疗; 淋巴结持续受累; 预后
Keywords:
Rectal cancer; Neoadjuvant therapy; Continuous lymph node involvement; Prognosis
分类号:
R735.3+7
DOI:
10.3969/j.issn.1006-1959.2022.17.012
文献标志码:
A
摘要:
目的 探讨新辅助放化疗（nCRT）后行根治性切除术的局部进展期的直肠癌患者术后淋巴结持续受累的可能临床病理因素。方法 收集2016年1月-2019年1月就诊于重庆医科大学附属第一医院胃肠外科的局部进展期直肠癌患者103例的临床病理资料。根据术后淋巴结受累情况将患者分为ypN0和ypN+两组，分析其术后淋巴结持续受累可能的临床病理因素及预后。结果 有36例患者术后出现淋巴结持续受累（34.95%）；治疗前N分期处于N2期的患者术后出现淋巴结持续受累者（41.33%）高于术前N分期处于N1期者（17.86%），差异有统计学意义（P＜0.05）；治疗前CEA≥5 μg/L的患者术后出现淋巴结持续受累者（47.27%）高于术前CEA＜5 μg/L者（20.83%），差异有统计学意义（P＜0.05）；治疗前EMVI阳性的患者术后出现淋巴结持续受累者（43.75%）高于治疗前EMVI阴性者（20.51%），差异有统计学意义（P＜0.05）；多因素分析结果提示患者CEA≥5 μg/L（OR=0.366，95%CI：0.147~0.913，P=0.031）、治疗前EMVI阳性（OR=0.347，95%CI：0.132~0.914，P=0.032）是新辅助治疗术后淋巴结持续受累的独立危险因素；生存分析结果提示ypN1患者的总生存率（OS）为65.7%，低于ypN0患者的95.5%，差异有统计学意义（P＜0.05）。结论 新辅助治疗前判断患者CEA水平及准确评估壁外血管侵犯情况有助于评估患者NCRT术后淋巴结消退情况，从而更好的指导局部进展期直肠癌患者的个体化治疗方案。
Abstract:
Objective To investigate the possible clinicopathological factors of persistent lymph node involvement in locally advanced rectal cancer patients undergoing radical resection after neoadjuvant chemoradiotherapy (nCRT).Methods The clinicopathological data of 103 patients with locally advanced rectal cancer who were admitted to the Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2019 were collected. According to the postoperative lymph node involvement, the patients were divided into ypN0 and ypN+ groups, and the possible clinicopathological factors and prognosis of persistent lymph node involvement were analyzed.Results Persistent lymph node involvement occurred in 36 patients (34.95%). The incidence of persistent lymph node involvement in patients with N2 stage before treatment (41.33%) was higher than that in patients with N1 stage (17.86%), and the difference was statistically significant (P<0.05). Patients with CEA≥5 μg/L before treatment had persistent lymph node involvement (47.27%), which was higher than those with CEA less than 5 μg/L before treatment (20.83%), and the difference was statistically significant (P<0.05). Patients with positive EMVI before treatment had persistent lymph node involvement (43.75%), which was higher than those with negative EMVI before treatment (20.51%), and the difference was statistically significant (P<0.05). Multivariate analysis showed that CEA≥5 μg/L (OR=0.366,95%CI:0.147-0.913, P=0.031) and positive EMVI before treatment (OR=0.347,95%CI:0.132-0.914, P=0.032) were independent risk factors for persistent lymph node involvement after neoadjuvant therapy. Survival analysis showed that the overall survival (OS) of ypN1 patients was 65.7%, which was lower than 95.5% of ypN0 patients, and the difference was statistically significant (P<0.05).Conclusion The determination of CEA level before neoadjuvant therapy and the accurate assessment of extramural vascular invasion are helpful to evaluate the lymph node regression after NCRT, so as to better guide the individualized treatment of patients with locally advanced rectal cancer.

参考文献/References:

[1]Siegel RL,Miller KD,Fedewa SA,et al.Colorectal cancer statistics, 2017[J].CA Cancer J Clin,2017,67(3):177-193.[2]Benson AB 3rd,Venook AP,Bekaii-Saab T,et al.Rectal Cancer,Version 2.2015[J].J Natl Compr Canc Netw,2015,13(6):719-728.[3]Chetty R,Gill P,Bateman AC,et al.Pathological grading of regression: An International Study Group perspective[J].J Clin Pathol,2012,65:865-866.[4]Arman E,Alvaro M,Maude T,et al.Monson,Impact of residual nodal involvement after complete tumor response in patients undergoing neoadjuvant (chemo)radiotherapy for rectal cancer[J].Surgery,2019,166(4):648-654.[5]Zhu LY,Gao ZD,Ye YJ.The significance of lymph node yield in rectal cancer after neoadjuvant chemotherapy[J].Chin J Gastrointest Surg,2019,22(9):896-900.[6]Chetty R,Gill P,Bateman AC,et al.Pathological grading of regression: An International Study Group perspective[J].J Clin Pathol,2012,65:865-866.[7]Fernández-Ace?觡ero MJ,Granja M,Sastre J,et al.Prognostic significance of tumor regression in lymph nodes after neoadjuvant therapy for rectal carcinoma[J].Virchows Arch,2016,468(4):425-430.[8]Li J,Yuan J,Liu H,et al.Lymph nodes regression grade is a predictive marker for rectal cancer after neoadjuvant therapy and radical surgery[J].Oncotarget,2016,7(13):16975-16984.[9]Mirbagheri N,Kumar B,Deb S,et al.Lymph node status as a prognostic indicator after preoperative neoadjuvant chemoradiotherapy of rectal cancer[J].Colorectal Dis,2014,16(10):O339-O346.[10]Yimei J,Ren Z,Lu X,et al.A comparison between the reference values of MRI and EUS and their usefulness to surgeons in rectal cancer[J].Eur Rev Med Pharmacol Sci,2012,16(15):2069-2077.[11]Chen S,Li N,Tang Y,et al.The prognostic value of MRI-detected extramural vascular invasion (mrEMVI) for rectal cancer patients treated with neoadjuvant therapy: a meta-analysis[J].Eur Radiol,2021,31(12):8827-8837.[12]Hamabe A,Ishii M,Onodera K,et al.MRI-detected extramural vascular invasion potentiates the risk for pathological metastasis to the lateral lymph nodes in rectal cancer[J].Surg Today,2021,51(10):1583-1593.[13]Zhang XY,Wang S,Li XT,et al.MRI of Extramural Venous Invasion in Locally Advanced Rectal Cancer: Relationship to Tumor Recurrence and Overall Survival[J].Radiology,2018,289(3):677-685.[14]van den Broek JJ,van der Wolf FSW,Heijnen LA,et al.The prognostic importance of MRI detected extramural vascular invasion (mrEMVI) in locally advanced rectal cancer[J].Int J Colorectal Dis,2020,35(10):1849-1854.[15]Talbot IC,Ritchie S,Leighton MH,et al.The clinical significance of invasion of veins by rectal cancer[J].Br J Surg,1980,67(6):439-442.[16]Tripathi P,Li Z,Shen Y,et al.Risk of nodal disease in patients with MRI-detected extramural vascular invasion in rectal cancer: a systematic review and meta-analysis[J].Tumori,2021,107(6):564-570.[17]Liu L,Liu M,Yang Z,et al.Correlation of MRI-detected extramural vascular invasion with regional lymph node metastasis in rectal cancer[J].Clin Imaging,2016,40(3):456-460.[18]Dinaux AM,Leijssen L,Bordeianou LG,et al.Berger,Outcomes of persistent lymph node involvement after neoadjuvant therapy forstage Ⅲ rectal cancer[J].Surgery,2018,163(4):784-788.[19]Tominaga T,Akiyoshi T,Yamamoto N,et al.Prognostic value of metastatic lymph node regression grade after neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer[J].Surgery,2019,166(6):1061-1067.

相似文献/References:

[1]王梦荷,闵 利,李亚玲.Roy适应模式对直肠癌Miles术后结肠造口患者适应水平及家庭负担影响的研究[J].医学信息,2018,31(09):163.[doi:10.3969/j.issn.1006-1959.2018.09.054]
　WANG Meng-he,MIN Li,LI Ya-ling.Effect of Roy Adaptation Mode on Adaptation Level and Family Burden of Colostomy Patients after Rectal Cancer Miles Operation[J].Journal of Medical Information,2018,31(17):163.[doi:10.3969/j.issn.1006-1959.2018.09.054]
[2]张淑贞.永久性肠造口患者延续性护理的研究进展[J].医学信息,2018,31(11):63.[doi:10.3969/j.issn.1006-1959.2018.11.020]
　ZHANG Shu-zhen.Research Progress of Continuing Nursing for Patients with Permanent Enterostomy[J].Journal of Medical Information,2018,31(17):63.[doi:10.3969/j.issn.1006-1959.2018.11.020]
[3]蔡 彬,黄 伟,储正达,等.直肠腔内超声与相控阵线圈磁共振在直肠癌术前局部分期中的Meta分析[J].医学信息,2019,32(10):70.[doi:10.3969/j.issn.1006-1959.2019.10.024]
　CAI Bin,HUANG Wei,CHU Zheng-da,et al.Meta-analysis of Intra-rectal Ultrasound and Phased-array Magnetic Resonance in the Preoperative Partial Phase of Rectal Cancer[J].Journal of Medical Information,2019,32(17):70.[doi:10.3969/j.issn.1006-1959.2019.10.024]
[4]吴忠亮,林 毅,张兴发.新辅助治疗后行结直肠癌根治术的患者术后并发症发生情况及预后预测因素分析[J].医学信息,2022,35(16):90.[doi:10.3969/j.issn.1006-1959.2022.16.021]
　WU Zhong-liang,LIN Yi,ZHANG Xing-fa.Analysis of Postoperative Complications and Prognostic Factors in Patients Undergoing Radical Resection of Colorectal Cancer After Neoadjuvant Therapy[J].Journal of Medical Information,2022,35(17):90.[doi:10.3969/j.issn.1006-1959.2022.16.021]
[5]刘 峰,吴晓丽,谢建军.腹腔镜直肠癌全系膜切除术对直肠癌患者远期排尿功能的影响[J].医学信息,2020,33(04):104.[doi:10.3969/j.issn.1006-1959.2020.04.031]
　LIU Feng,WU Xiao-li,XIE Jian-jun.Effect of Laparoscopic Total Mesorectal Excision on Rectal Cancer Patients with Long-term Urination Function[J].Journal of Medical Information,2020,33(17):104.[doi:10.3969/j.issn.1006-1959.2020.04.031]
[6]杨建国,陈清伟,李金豆,等.直肠癌新辅助放化疗与手术间隔时间对临床和肿瘤学结局的影响[J].医学信息,2020,33(10):90.[doi:10.3969/j.issn.1006-1959.2020.10.024]
　YANG Jian-guo,CHEN Qing-wei,LI Jin-dou,et al.Effects of Neoadjuvant Radiochemotherapy and Operation Interval of Rectal Cancer on Clinical and Oncological Outcomes[J].Journal of Medical Information,2020,33(17):90.[doi:10.3969/j.issn.1006-1959.2020.10.024]
[7]周 涛.Ⅱ、Ⅲ期直肠癌Ki-67及微卫星不稳定的表达对预后的影响[J].医学信息,2021,34(23):66.[doi:10.3969/j.issn.1006-1959.2021.23.018]
　ZHOU Tao.Effect of Ki-67 and Microsatellite Instability on Prognosis in Stage Ⅱ and Ⅲ Rectal Cancer[J].Journal of Medical Information,2021,34(17):66.[doi:10.3969/j.issn.1006-1959.2021.23.018]
[8]罗章才,钟绍东,陈康福.瑞芬太尼联合丙泊酚靶控输注对超低位直肠癌手术患者术后苏醒时间及并发症的影响[J].医学信息,2021,34(24):77.[doi:10.3969/j.issn.1006-1959.2021.24.016]
　LUO Zhang-cai,ZHONG Shao-dong,CHEN Kang-fu.Effect of Remifentanil Combined with Propofol Target-controlled Infusion on Postoperative Recovery Time and Complications in Patients with Ultra-low Rectal Cancer[J].Journal of Medical Information,2021,34(17):77.[doi:10.3969/j.issn.1006-1959.2021.24.016]
[9]王 辉,刘爱芬.NOTES腹腔镜下直肠癌根治术治疗直肠癌的效果[J].医学信息,2020,33(17):95.[doi:10.3969/j.issn.1006-1959.2020.17.027]
　WANG Hui,LIU Ai-fen.The Effect of Laparoscopic Radical Resection of Rectal Cancer in the Treatment of Rectal Cancer by NOTES[J].Journal of Medical Information,2020,33(17):95.[doi:10.3969/j.issn.1006-1959.2020.17.027]
[10]梁 杨,胡燕华,王 梅,等.直肠癌术后患者性功能障碍的影响因素及护理现状[J].医学信息,2020,33(23):52.[doi:10.3969/j.issn.1006-1959.2020.23.016]
　LIANG Yang,HU Yan-hua,WANG Mei,et al.Influencing Factors and Nursing Status of Patients with Sexual Dysfunction After Rectal Cancer Operation[J].Journal of Medical Information,2020,33(17):52.[doi:10.3969/j.issn.1006-1959.2020.23.016]

更新日期/Last Update: 1900-01-01