| 摘要: |
| 目的研究新辅助治疗对局部进展期中低位直肠癌患者术后淋巴结检出数及阳性淋巴结数的影响，探讨肿瘤T分期与放疗灵敏度的关系及淋巴结状况与预后的关系。方法回顾性研究216例采用直肠全系膜切除术（TME手术）治疗的中低位直肠癌患者的临床资料，将其中接受新辅助治疗后再手术的106例患者设为观察组，未行新辅助治疗直接手术的110例患者设为对照组，比较两组临床资料及术后淋巴结检出情况，同时研究新辅助治疗后肿瘤T分期与放疗灵敏度之间的关系，采用生存曲线分析新辅助治疗后淋巴结情况与预后的关系。结果观察组患者术后标本淋巴结检出数[6.5（4.5，15.0）枚]及阳性淋巴结检出数[1.0（0，4.0）枚]均少于对照组[11.0（8.5，17.5）、2.5（1.5，5.0）枚]，差异均有统计学意义（U=11.60、2.05，均P＜0.05）。肿瘤T分期与放疗灵敏度相关（r=0.97，P＜0.01）。观察组淋巴结阴性患者5年生存率（78.0%）高于淋巴结阳性患者（50.4%），两者比较差异有统计学意义（字2=8.84，P＜0.01），观察组淋巴结阴性患者中检出淋巴结总数≥12枚患者5年生存率（80.8%）高于＜12枚患者（63.0%），但差异无统计学意义（字2=0.164，P＞0.05）。结论新辅助治疗使中低位直肠癌患者术后总淋巴结及阳性淋巴结数减少，肿瘤T分期与放疗灵敏度相关，新辅助治疗后淋巴结阳性患者预后不良，增加淋巴结检出数可能提高新辅助治疗后淋巴结阴性患者总体生存率。 |
| 关键词: 直肠肿瘤 新辅助治疗 淋巴结状况 |
| DOI：10.12056/j.issn.1006-2785.2017.39.13.2016-830 |
| 分类号: |
| 基金项目:国家自然科学基金资助项目（30973460，81272561）；浙江省医药卫生科技计划资助项目（2015KYA153）；温州市科技局科研基金资助项目（Y20140372，Y20150710） |
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| Prognostic value of lymph node status after neoadjuvant chemoradiation therapy in patients with locally advanced mid-low rectal cancer |
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ZUO Zhigui, WANG Hao, GAO Xianhua, YU Zhiqi, ZHANG Chuang, CHAI Rui, FU Chuangang
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the First Affiliated Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To investigate the associationof lymph node status after neoadjuvant chemoradiation therapy (NCRT) in patients with locally advanced rectal cancer (LARC). Methods Clinical data of 216 patients with LARC receiving radical tumor resection were analysized retrespectively, including 106 patients (study group) with NCRT followed by radical tumor resection 110 patients (control group) undergoing primary surgery without NCRT. The total lymph nodes (LNs) retrieval and the number of positive LNs was compared between the two groups. The correlation between T stage and radiosensitivity was analysized, and the association of LN status with prognosis of patients was evaluated with Kaplan-Meier survival curve. Results The number of total LNs and positive LNs harvested from each resected specimen in the control group were 10.62±0.36 and
2.32±0.33, while those were 8.12±0.38 and 0.84±0.12 in study group (P＜0.001 and P=0.04). T stage was associated with the tumor pathological response after NCRT(r=0.97, P＜0.01). In study group, the 5-year overall survival rate in patients with negative LNs was significantly higher than that in patients with positive LNs (78.0% vs 50.4%, 字2=8.836, P=0.003), however, there was no significant difference in the overall survival between patients with ≥12 Lns andthose with ＜12 LNs (80.8% vs 63.0%, 字2=0.164,
P=0.686). Conclusion NCRT reduces the number of LNs retrieval and the positive LNs in LARC; negative LNs after NCRT may improve the prognosis of LARC patients. |
| Key words: Rectal neoplasm Neoadjuvant chemoradiation therapy Lymph node status |
