新辅助化疗对直肠癌术后淋巴结检出数目的影响

Neoadjuvant chemotherapy decreases lymph node harvest in rectal cancer

目的 探讨新辅助化疗对根治性直肠癌切除手术标本淋巴结检出数目的影响。方法选取2011-01-01-2013-12-31中山大学附属第三医院胃肠外科收治并行根治性切除手术的125例中低位直肠癌患者为研究对象,按是否接受新辅助化疗分为新辅助组（n=42）和对照组（单纯手术,n=83）。新辅助化疗方案选用mFOLFOX6方案,即奥沙利铂85mg/m^2,静脉滴入,d1;亚叶酸钙200mg/m^2,静脉滴入,d1;5-FU 400mg/m^2,静脉推注,d1,随后5-FU 2.0g/m^2,加入化疗泵持续静脉滴入48h,每2周重复。或者XELOX（CapeOX）方案,即奥沙利铂130mg/m^2,静脉滴入,d1;卡培他滨2 000mg/m^2,口服,d1-d14,每3周重复。对两组病例的临床资料和淋巴结检出数目进行对比和统计学分析。结果在相同的手术标准和病理处理程序下,新辅助组淋巴结检出数目为（6.1±5.3）枚/例,对照组为（15.3±4.1）枚/例,新辅助组较对照组明显减少,t=10.71,P〈0.001。新辅助组和对照组直径〈5mm的小淋巴结分别占43%和14%,χ^2=82.56,P〈0.001。新辅助组和对照组淋巴结检出数目≥12枚分别为15例（35.7%）和59例（71.1%）,χ^2=17.97,P〈0.001。检出淋巴结的大小、数目与新辅助化疗的疗效无关。结论 新辅助化疗可导致直肠癌手术标本的淋巴结检出数目减少、淋巴结直径变小,这与手术质量、病理处理程序和化疗疗效无关。

OBJECTIVE To evaluate the effect of neoadjuvant chemotherapy on lymph node harvest in rectal cancer patients undergoing radical operation.METHODS A database included 125 patients with middle or lower rectal cancer who received radical operation in the Third Affiliated Hospital of Sun Yat-sen University from 2011 to 2013were retrospectively queried.Data of clinicopathologic features and lymph node harvest were analyzed.RESULTS Neoadjuvant chemotherapy group included 42 cases who received neoadjuvant chemotherapy;the other cases were defined as control group.The average number of detected lymph node in neoadjuvant chemotherapy group and control group were 6.1±5.3and 15.3±4.1respectively（t=10.71,P〈0.001）.Proportion of lymph nodes smaller than 5mm in neoadjuvant chemotherapy group and control group were 43% and 14% respectively（χ2=82.56,P〈0.001）.Proportion of patients with lymph node harvest not less than 12 in neoadjuvant chemotherapy group and control group were 35.7% and 71.1% respectively（χ2=17.97,P〈0.001）.Response to neoadjuvant chemotherapy was not a significant factor in lymph node harvest.CONCLUSION Neoadjuvant therapy decreased lymph node retrieval and lymph node size in rectal cancer.