中低位直肠癌术前放化疗后原发瘤消退与淋巴结转移的关系

Association between primary tumor regression and lymph node status after neoadjuvant chemoradiotherapy in mid and low rectal cancer

目的探讨淋巴结转移情况与肿瘤消退在中低位直肠癌术前放化疗后的关系。方法回顾性分析2003年1月至2010年11月间北京军区总医院收治的71例局部进展期（T3～4NxM0）中低位直肠癌（肿瘤位于腹膜反折以下）患者的临床资料。对切除术后标本进行病理检查，了解淋巴结状态和原发肿瘤之间的关系。结果71例患者全部按计划完成术前放化疗,12例获得病理完全缓解，其中1例未行手术，予以随访观察。70例接受直肠癌根治术的患者术后病理示，39例原发肿瘤降至T0-2期，其中淋巴结转移5例（12．8％）；31例原发肿瘤仍处于B。期，其中淋巴结转移10例（32．3％）；两者比较差异有统计学意义（P=0．029）。结论中低位直肠癌术前放化疗后，肿瘤消退程度与淋巴结转移减少具有一致性。

Objective To analyze the association between the response of primary tumor to neoadjuvant chemoradiotherapy （CRT） and lymph node status in mid and low rectal cancer. Methods Seventy-one patients with locally advanced mid and low rectal cancer underwent preoperative CRT followed by surgery. Surgical specimens were examined by surgeons and pathologists to obtain more lymph nodes and the histological sections were examined. Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and tumor regression. Statistical analyses were performed to investigate the relationship between tumor regression and lymph node status. Results All the patients completed the neoadjuvant CRT. Twelve patients achieved pathological complete response, of whom one was not operated and on surveillance. Pathological examination of the remaining 70 patients showed that the tumor was downstaged to T 0-2 group in 39 patients, among whom 5 patients （12.8%） had positive lymph nodes. Tumor was not downstaged in 31 patients, of whom 10 patients （32.3%） had positive nodes. The difference between the two groups was statistically significant （P=0.029）. Conclusion Tumor regression is consistent with the reduction of lymph node metastasis after preoperative CRT.