局部进展期直肠癌新辅助放化疗术后淋巴结持续受累的临床病理因素及预后分析

Clinicopathological Factors and Prognostic Analysis of Persistent Lymph Node Involvement After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

目的 探讨新辅助放化疗(nCRT)后行根治性切除术的局部进展期的直肠癌患者术后淋巴结持续受累的可能临床病理因素。方法 收集2016年1月-2019年1月就诊于重庆医科大学附属第一医院胃肠外科的局部进展期直肠癌患者103例的临床病理资料。根据术后淋巴结受累情况将患者分为ypN0和ypN+两组,分析其术后淋巴结持续受累可能的临床病理因素及预后。结果 有36例患者术后出现淋巴结持续受累(34.95%);治疗前N分期处于N_(2)期的患者术后出现淋巴结持续受累者(41.33%)高于术前N分期处于N_(1)期者(17.86%),差异有统计学意义(P<0.05);治疗前CEA≥5μg/L的患者术后出现淋巴结持续受累者(47.27%)高于术前CEA<5μg/L者(20.83%),差异有统计学意义(P<0.05);治疗前EMVI阳性的患者术后出现淋巴结持续受累者(43.75%)高于治疗前EMVI阴性者(20.51%),差异有统计学意义(P<0.05);多因素分析结果提示患者CEA≥5μg/L(OR=0.366,95%CI:0.147~0.913,P=0.031)、治疗前EMVI阳性(OR=0.347,95%CI:0.132~0.914,P=0.032)是新辅助治疗术后淋巴结持续受累的独立危险因素;生存分析结果提示ypN_(1)患者的总生存率(OS)为65.7%,低于ypN0患者的95.5%,差异有统计学意义(P<0.05)。结论 新辅助治疗前判断患者CEA水平及准确评估壁外血管侵犯情况有助于评估患者NCRT术后淋巴结消退情况,从而更好的指导局部进展期直肠癌患者的个体化治疗方案。

Objective To investigate the possible clinicopathological factors of persistent lymph node involvement in locally advanced rectal cancer patients undergoing radical resection after neoadjuvant chemoradiotherapy(nCRT).Methods The clinicopathological data of 103 patients with locally advanced rectal cancer who were admitted to the Department of Gastrointestinal Surgery,the First Affiliated Hospital of Chongqing Medical University from January 2016 to January 2019 were collected.According to the postoperative lymph node involvement,the patients were divided into ypN0 and ypN+ groups,and the possible clinicopathological factors and prognosis of persistent lymph node involvement were analyzed.Results Persistent lymph node involvement occurred in 36 patients(34.95%).The incidence of persistent lymph node involvement in patients with N_(2) stage before treatment(41.33%) was higher than that in patients with N_(1) stage(17.86%),and the difference was statistically significant(P<0.05).Patients with CEA≥5 μg/L before treatment had persistent lymph node involvement(47.27%),which was higher than those with CEA less than 5 μg/L before treatment(20.83%),and the difference was statistically significant(P <0.05).Patients with positive EMVI before treatment had persistent lymph node involvement(43.75%),which was higher than those with negative EMVI before treatment(20.51%),and the difference was statistically significant( P <0.05).Multivariate analysis showed that CEA≥5 μg/L(OR=0.366,95%CI:0.147-0.913,P=0.031) and positive EMVI before treatment(OR=0.347,95%CI:0.132-0.914,P=0.032) were independent risk factors for persistent lymph node involvement after neoadjuvant therapy.Survival analysis showed that the overall survival(OS) of ypN_(1) patients was 65.7%,which was lower than 95.5% of yp N0 patients,and the difference was statistically significant( P<0.05).Conclusion The determination of CEA level before neoadjuvant therapy and the accurate assessment of extramural vascular invasion are helpful to evaluate the lymph node regression after NCRT,so as to better guide the individualized treatment of patients with locally advanced rectal cancer.