102例直肠癌侧方淋巴结转移患者临床病理特点及生存预后分析  

Clinicopathological Characteristics and Survival Prognosis Analysis of 102 Rectal Cancer Patients with Lateral Pelvic Lymph Node Metastases

作　　者：周思成 武海峰 潘雨婷 云红 曹少木 聂红霞 兴伟[3] 梁建伟 ZHOU Sicheng;WU Haifeng;PAN Yuting;YUN Hong;CAO Shaomu;NIE Hongxia;XING Wei;LIANG Jianwei(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,Xinzhou City People’s Hospital,Xinzhou 140900,China;Department of General Surgery,Hebei Province Hospital of Chinese Medicine,Affiliated Hospital of Hebei University of Chinese Medicine,Shijiazhuang 050000,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]山西医科大学附属忻州医院、第十临床医学院/忻州市人民医院普外科,忻州140900 [3]国家中医临床研究基地/河北省中医院外一科,石家庄050000

出　　处：《肿瘤防治研究》2023年第1期33-37,共5页Cancer Research on Prevention and Treatment

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2020A37)。

摘　　要：目的探讨侧方淋巴结清扫术(LPLND)在侧方淋巴结(LPLN)转移患者中的治疗效果及预后意义。方法回顾性分析2012年1月—2020年12月在中国医学科学院肿瘤医院和北京大学第一医院行全直肠系膜切除术(TME)联合LPLND术后病理证实LPLN转移的直肠癌患者的临床病理资料。探讨LPLN转移患者临床病理特点与转移规律,同时进行预后分析。结果共纳入102例病理证实LPLN转移的直肠癌患者。LPLN常见转移部位依次为髂内淋巴结(n=68,66.7%)、闭孔淋巴结(n=44,43.1%)和髂总/髂外淋巴结(n=12,11.8%)。10例(9.8%)患者出现双侧LPLN转移,平均LPLN转移数量为2.2±2.4,其中16例(15.7%)患者LPLN转移数量≥2。LPLN转移至髂外/髂总淋巴结的患者3年总体生存率(OS)(66.8%vs.7.7%,P<0.001)与无瘤生存率(DFS)(39.1%vs.10.5%,P=0.012)明显低于转移至髂内/闭孔淋巴结转移的患者。多因素分析显示LPLN转移至髂外/髂总是影响OS(HR=3.53;95%CI:1.50~8.31;P=0.004)和DFS(HR=2.40;95%CI:1.05~5.47;P=0.037)的共同独立危险因素。结论LPLN转移主要位于髂内血管与闭孔区域。转移至髂外或髂总淋巴结患者的生存预后无法通过LPLND改善,全身性综合治疗往往是此类患者的最佳治疗选择。Objective To investigate the therapeutic effect and prognostic significance of lateral lymph node dissection(LPLND)in patients with lateral lymph node(LPLN)metastasis.Methods The clinicopathological data of rectal cancer patients who underwent total mesorectal excision(TME)combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed.The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed,and the survival prognosis after LPLND was analyzed.Results A total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included.The common sites of LPLN metastasis were internal iliac vessels lymph nodes(n=68,66.7%),followed by obturator lymph nodes(n=44,43.1%),and common iliac vessels or external iliac vessels lymph nodes(n=12,11.8%).There were 10 patients(9.8%)with bilateral LPLN metastases,and the mean number of LPLN metastases was 2.2±2.4,among which 16 patients(15.7%)had LPLN metastases number≥2.The 3-year OS(66.8%vs.7.7%,P<0.001)and DFS(39.1%vs.10.5%,P=0.012)of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node.The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS(HR=3.53;95%CI:1.50-8.31;P=0.004)and DFS(HR=2.40;95%CI:1.05-5.47;P=0.037).Conclusion LPLN mainly metastasizes to the internal iliac or obturator lymph node areas.The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND,and thus systemic comprehensive treatment is often the optimal treatment option.

关 键 词：侧方淋巴结清扫术 侧方淋巴结转移 生存预后 直肠癌 

分 类 号：R656.9[医药卫生—外科学] R735.3[医药卫生—临床医学]