局部治疗在直肠癌盆腔侧方淋巴结转移中的作用

Effect of local treatment on lateral pelvic lymph node metastasis in rectal cancer

盆腔侧方淋巴结(LPLN)转移是直肠癌预后不佳因素, 在低位、T3-T4期、直肠系膜淋巴结阳性情况下更常见, 但无准确预测转移的因素。高分辨率MRI是目前诊断LPLN转移的首选手段, 但阈值选择仍不明确。局部进展期直肠癌的侧方淋巴结转移治疗模式在全球存在分歧, 欧美国家主张放化疗联合直肠全系膜切除术, 而日本推荐直肠全系膜切除术联合LPLN清扫。放疗与手术联合可取得很好的局控, 利用放疗前、后MRI的侧方淋巴结信息, 可筛选出高危患者进行强化治疗, 如放化疗后行LPLN清扫或LPLN区放疗推量。目前各种手段在治疗LPLN转移方面的作用仍缺乏高质量证据, 尚需更多的研究来改善治疗策略。

Lateral pelvic lymph node(LPLN)metastasis is a poor prognostic factor for rectal cancer,which is more common in low site,T3-T4 stage,and positive lymph nodes in mesorectum.However,there is no accurate predictor of metastasis.At present,high-resolution MRI is the optimal diagnosis of LPLN metastasis,but the threshold value is still unclear.The treatment mode of LPLN metastasis in locally advanced rectal cancer is controversial worldwide.European and American countries advocate chemoradiotherapy combined with total mesorectal resection,while Japan recommends total mesorectal resection combined with LPLN dissection.The combination of radiotherapy and surgery could achieve good local control.Further more,by using the information of lateral lymph nodes before and after radiotherapy,patients with high risk can be screened for intensive treatment,such as LPLN dissection or dose-escalation approaches.Currently,there is still a lack of high-quality evidence on the efficacy of various approaches in the treatment of LPLN metastasis,and more research is needed to improve the treatment strategies.