侧方淋巴结转移特征对中低位直肠癌患者预后评估的价值  

The predictor value of lateral lymph node metastasis in the prognosis evaluation of middle-to-low rectal cancers

作　　者：梅世文 周思成 梁建伟 刘骞 汪欣[2] 王锡山 汤坚强 Shiwen Mei;Sicheng Zhou;Jianwei Liang;Qian Liu;Xin Wang;Xishan Wang;Jianqiang Tang(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;Department of General Surgery,Peking University First Hospital,Beijing 100032,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]北京大学第一医院普通外科,100032

出　　处：《中华结直肠疾病电子杂志》2022年第6期465-473,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.2021-0402)。

摘　　要：目的分析中低位直肠癌侧方淋巴结转移临床病理特征,进一步评估侧方淋巴结转移特征对生存预后评估的价值。方法回顾性收集并分析2012年1月至2019年12月来自中国医学科学院肿瘤医院和北京大学第一医院行直肠癌侧方淋巴结清扫(LLND)的269例患者的临床病理资料及随访结果。根据术后病理结果将患者分为侧方淋巴结阳性组63例和阴性组206例,分别比较两组的临床病理结果,分析全组3年总生存(OS)和无复发生存率(RFS)的影响因素,并进一步分析影响侧方淋巴结阳性患者3年OS和RFS的危险因素。结果纳入269例LLND患者侧方淋巴结转移率为23.4%,肿瘤病理组织学类型(χ^(2)=13.527,P<0.001),浸润深度(χ^(2)=6.849,P=0.009),系膜淋巴结转移(χ^(2)=39.716,P<0.001),神经侵犯(χ^(2)=7.126,P=0.008)与脉管瘤栓(χ^(2)=5.554,P=0.018)是影响侧方淋巴结转移的重要因素。中位随访时间41个月,侧方淋巴结病理阳性组3年OS和RFS分别为58.2%和47.3%,侧方淋巴结阴性组3年OS和RFS分别为89.4%和78.51%。Cox多因素回归分析显示:系膜淋巴结转移和侧方淋巴结转移是影响LLND患者OS(HR=2.25,95%CI=1.00~5.04,P=0.049;HR=3.11,95%CI=1.60~6.03,P=0.001)和RFS(HR=2.76,95%CI=1.49~5.12,P=0.001;HR=2.51,95%CI=1.47~4.29,P=0.001)的独立危险因素。Cox多因素回归分析显示侧方淋巴结转移部位是影响侧方淋巴结转移阳性亚组OS(HR=4.54,95%CI=1.64~10.90,P=0.045)和RFS(HR=3.77,95%CI=1.93~9.35,P=0.021)的独立危险因素。结论系膜淋巴结和侧方淋巴结转移是中低位直肠癌预后不良的独立危险因素,侧方淋巴结转移范围超出髂内和闭孔区域的患者预后更差,可能无法通过侧方淋巴结清扫获益。Objective To investigate the clinicopathological characteristics of lateral lymph node metastasis in middle-to-low rectal cancers,and to further evaluate the value of the characteristics of lateral lymph node metastasis in the assessment of survival prognosis.Methods The clinicopathological data and follow-up results of 269 patients who underwent lateral lymph node dissection(LLND)for rectal cancers from January 2012 to December 2019 in Cancer Hospital of Chinese Academy of Medical Sciences and Peking University First Hospital were retrospectively collected and analyzed.According to the postoperative pathological results,the patients were divided into the lateral lymph node positive group(n=63)and the negative group(n=206).The clinicopathological results of the two groups were compared respectively.The risk factors of 3-year OS and RFS in patients with positive lateral lymph nodes were further analyzed.Results A total of 269 patients were included in the study,and the lateral lymph nodes metastasis rate was 23.4%.Tumor histopathological type(χ^(2)=13.527,P<0.001),depth of invasion(χ^(2)=6.849,P=0.009),mensenteric lymph node metastasis(χ^(2)=39.716,P<0.001),nerve invasion(χ^(2)=7.126,P=0.008)and lymphatic vessel invasion(χ^(2)=5.554,P=0.018)were important factors affecting lateral lymph node metastasis.The median follow-up time was 41 months.The 5-year OS and RFS were 58.2%and 47.3%in the positive group and 89.4%and 78.51%in the negative group,respectively.Cox multivariate regression analysis showed that:mensenteric lymph node metastasis and lateral lymph node metastasis were associated with OS(HR=2.25,95%CI=1.00~5.04,P=0.049;HR=3.11,95%CI=1.60~6.03,P=0.001)and RFS(HR=2.76,95%CI=1.49~5.12,P=0.001;HR=2.51,95%CI=1.47~4.29,P=0.001).Cox multivariate regression analysis found that the location of lateral lymph node metastasis was an independent risk factor for OS(HR=4.54,95%CI=1.64~10.90,P=0.045)and RFS(HR=3.77,95%CI=1.93~9.35,P=0.021).Conclusions Mensenteric lymph node and lateral lymph node metastasis are indepe

关 键 词：直肠肿瘤 侧方淋巴结转移 预后 

分 类 号：R735.37[医药卫生—肿瘤]