盆腔侧方淋巴结转移对低位直肠癌预后的影响

Lateral pelvic lymph node metastasis is an important prognostic factor for low rectal cancer

目的探讨盆腔侧方淋巴结转移对低位直肠癌预后的影响。方法对1994年至2005年行根治性切除联合盆腔侧方淋巴结清扫的176例低位直肠癌患者的资料进行回顾性分析。探讨低位直肠癌患者盆腔侧方淋巴结转移对其预后的影响。结果全组盆腔侧方淋巴结转移33例（18．8％），其中髂内及直肠中动脉根部淋巴结转移占51．5％，闭孔淋巴结转移占39．4％。年龄≤40岁、浸润型癌、T3-4期、上方淋巴结转移患者的盆腔侧方淋巴结转移率较高（P〈0．05）。全组5年生存率为64．1％，TNM分期Ⅰ、Ⅱ、Ⅲ期患者5年生存率分别为94．1％、79．1％、42．1％。癌灶大小、浸润深度、上方淋巴结转移、盆腔侧方淋巴结转移是影响低位直肠癌患者预后的重要因素（P〈0．05）。盆腔侧方淋巴结阴性患者5年生存率为73．6％，而侧方淋巴结转移患者为21．4％，两组差异具有统计学意义（P〈0．05）。结论盆腔侧方淋巴结转移是影响低位直肠癌预后的重要因素。

Objective To evaluate the prognostic value of lateral pelvic lymph node metastasis on low rectal cancer. Methods One hundred and seventy-six patients with low rectal cancer who underwent radical resection combined with lateral pelvic lymph node dissection between 1994 and 2005 were reviewed. The data of the cases was investigated to define the prognostic value of lateral pelvic lymph node metastasis on the patients. Results Lateral node metastasis occurred in 33 patients （ 18. 8% ） , and 51.5% of the metastasis occurred in internal iliac nodes or nodes at middle rectal roots and 39. 4% in obtarator nodes. Age ≤ 40 years, infiltrative cancer, T3--4 tumor, upward lymph node metastasis were risk factors for lateral node metastasis in low rectal cancer （P 〈 0.05）. The overall 5-year survival rate was 64. 1%, and it was 94. 1% , 79. 1% , 42. 1% for patients with TNM stage Ⅰ , Ⅱ, Ⅲ cancer, respectively. Tumor size, depth of infiltration, upward lymph node metastasis, lateral node metastasis was correlated significantly with prognosis （ P 〈 0. 05 ）. The 5-year survival rate of the patients without lateral metastasis was 73.6% , which was significant higher than that of patients with lateral metastasis （ 21.4% , P 〈 0. 05 ）. Conclusion Lateral pelvic lymph node metastasis is an important prognostic factor for low rectal cancer.