纳米碳淋巴结示踪技术在术前行放化疗食管胃结合部腺癌根治术中的应用价值

Application value of carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy

目的探讨纳米碳淋巴结示踪技术在术前行放化疗食管胃结合部腺癌根治术中的应用价值。方法采用回顾性队列研究方法。收集2014年1月至2017年11月北京大学肿瘤医院收治的56例行术前放化疗食管胃结合部腺癌患者的临床病理资料;男52例,女4例;平均年龄为62岁,年龄范围为22~76岁。56例患者中,17例行全胃切除+D2淋巴结清扫术,术中应用纳米碳标记示踪淋巴结,设为观察组;39例仅行全胃切除+D2淋巴结清扫术,设为对照组。观察指标:(1)治疗情况。(2)淋巴结检出情况。(3)围术期并发症情况。(4)随访情况。采用门诊和电话方式进行随访,了解患者术后肿瘤复发及转移情况。随访时间截至2019年5月。正态分布的计量资料以Mean±SD表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验;计数资料以绝对数表示,组间比较采用χ^2检验或Fisher确切概率法;等级资料比较采用非参数秩和检验。结果(1)治疗情况:两组患者术前成功行调强放疗为基础的同步放化疗,放化疗后均成功施行全胃切除+D2淋巴结清扫术,术中消化道重建均采用Roux-en-Y食管空肠吻合术。观察组患者手术时间、术中出血量分别为(217±58)min、(112±60)mL,对照组分别为(235±65)min、(119±77)mL,两组患者上述指标比较,差异均无统计学意义(t=1.017,0.341,P>0.05)。(2)淋巴结检出情况:观察组和对照组患者人均总淋巴结检出数目分别为(32±10)枚和(22±7)枚;人均靶区淋巴结数目分别为(21±8)枚和(16±5)枚;人均靶区周围淋巴结数目分别为(7±4)枚和(5±3)枚;两组患者上述指标比较,差异均有统计学意义(t=4.138,2.881,2.401,P<0.05)。观察组和对照组患者中位总阳性淋巴结检出数目分别为0枚(0~2枚)和0枚(0~7枚);中位阳性靶区淋巴结数目分别为0枚(0~2枚)枚和0枚(0~3枚);中位阳性靶区周围淋巴结数目分别为0枚(0~0枚)和0枚(0~1枚);两组患者上述指标比较,差异均无统计学意义(Z=1.305,1.101,0.660,P>0.05)。(3)围术期并发症情况:观察组和对照组患者术后分别有6例和18例发生并发症,两组比较,差异无统计学意义(χ^2=0.570,P>0.05),手术相关并发症经过药物治疗和局部治疗后好转,所有患者未进行二次手术。观察组患者围术期未见与注射纳米碳相关的局部或全身不良反应。(4)随访情况:56例患者均获得随访,随访时间为5~65个月,中位随访时间为32个月。观察组14例患者发生肿瘤复发及转移,对照组6例患者发生肿瘤复发及转移,两组比较,差异无统计学意义(χ^2=0.002,P>0.05)。结论纳米碳淋巴结示踪技术应用于术前行放化疗食管胃结合部腺癌根治术中,可提高淋巴结检出数目。

Objective To explore the application value of carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy. Methods The retrospective cohort study was conducted. The clinicopathological data of 56 patients with adenocarcinoma of esophagogastric junction who underwent preoperative chemoradiotherapy in the Peking University Cancer Hospital from January 2014 to November 2017 were collected. There were 52 males and 4 females, aged from 22 to 76 years, with an average age of 62 years. Among 56 patients undergoing total gastrectomy and D2 lymphadenectomy, 17 using carbon nanoparticle lymph node staining and 39 using traditional lymph node sorting were respectively allocated into observation group and control group. Observation indicators:(1) treatment situations;(2) detection of lymph nodes;(3) perioperative complications;(4) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence or metastasis up to May 2019. Measurement data with normal distribution were represented as Mean±SD, and comparison between groups was evaluated by the independent sample t test. Measurement data with skewed distribution were represented as M (range), and comparison between groups was evaluated by the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data was analyzed using the nonparametric rank sum test. Results (1) Treatment situations: patients in both groups were successfully treated with concurrent chemoradiotherapy based on intensity modulated radiotherapy before operation. Radical gastrectomy with D2 lymphadenectomy was successfully performed after chemoradiotherapy, and Roux-en-Y esophagojejunostomy was used to reconstruct the digestive tract during operation. The operation time and volume of intraoperative blood loss were respectively (217±58)minutes and (112±60)mL in the observation group, and (235±65)minutes and (119±77)mL in the control group, with no statistically significant difference between the two groups (t=1.017, 0.341, P>0.05).(2) Detection of lymph nodes: the average number of harvested lymph nodes, average number of radiation target lymph nodes, and average number of peritarget lymph nodes were respectively 32±10 , 21±8, and 7±4 in the observation group, and 22±7, 16±5, 5±3 in the control group, with statistically significant differences between the two groups (t=4.138, 2.881, 2.401, P<0.05). The median number of positive lymph nodes harvested, median number of positive radiation target lymph nodes, and median number of positive peritarget lymph nodes were respectively 0 (range, 0-2), 0 (range, 0-2), and 0 (range, 0-0) in the observation group, and 0 (range, 0-7), 0 (range, 0-3), and 0 (range, 0-1) in the control group, showing no statistically significant difference between the two groups (Z=1.305, 1.101, 0.660, P>0.05).(3) Perioperative complications: 6 and 18 patients in the observation group and the control group had complications, respectively, with no statistically significant difference between the two groups (χ^2=0.570, P>0.05). Patients with complications were improved after drug treatment and local treatment without second operation. No local or systemic adverse reactions caused by carbon nanoparticles was observed during and after operation in the observation group.(4) Follow-up: 56 patients were followed up for 5-65 months, with a median follow-up time of 32 months. There were 14 and 6 patients in the observation group and the control group with tumor recurrence or metastasis, respectively, showing no significant difference between the two groups (χ^2=0.002, P>0.05). Conclusion Carbon nanoparticle labeled lymph node staining in radical resection of adenocarcinoma of esophagogastric junction with preoperative chemoradiotherapy can increase the number of harvested lymph nodes.