基于MRI探索用于术前预测直肠癌侧方淋巴结转移的短径截断值

Explore the cutoff value of lateral pelvic lymph node short diameter for preoperative prediction of lateral pelvic lymph node metastasis of rectal cancer based on MRI

目的:探讨基于侧方淋巴结(lateral pelvic lymph node, LPLN)短径预测术前进行新辅助治疗和未进行新辅助治疗的直肠癌患者LPLN转移的诊断标准。方法:回顾性收集分析自2012年01月至2019年12月中国侧方淋巴结协作组的机构数据库中行全直肠系膜切除术(total mesorectal excision, TME)+侧方淋巴结清扫术(lateral pelvic lymph node metastasis, LPLND)的临床怀疑LPLN肿大的直肠癌患者的临床病理资料。结果:共纳入446例患者,根据不同术前治疗策略,将所有患者分为新辅助治疗组和无新辅助治疗组。新辅助治疗组患者病理pCR/T1(9.0%vs 2.7%,P=0.013)和N0(41.9%vs 55.3%,P<0.001)的比例与无新辅助治疗组患者差异明显。此外,相比于无新辅助治疗组患者,新辅助治疗组患者手术时间明显延长(300.7 vs 277.4 min,P=0.018)。新辅助治疗组与无新辅助治疗组分别有40例(25.8%)和78例(26.8%)患者病理诊断为LPLN转移。髂内淋巴结是新辅助治疗组(16.1%)和无新辅助治疗组(15.8%)患者最常见的LPLN转移位置。新辅助治疗组患者平均转移LPLN短径(1.0 vs 1.4 mm,P=0.015)和无转移LPLN短径(0.6 vs 0.8 mm,P=0.005)明显短于无新辅助治疗组。无新辅助治疗组和新辅助治疗组患者分别以9 mm和7 mm作为LPLN截断值时,AUC值分别为0.817和0.745,有着较好的一致性。结论:接受新辅助治疗和未接受新辅助治疗的患者分别以7 mm和9 mm作为LPLN截断值时,有着最佳的预测LPLN转移的能力。

Objective:To investigate the diagnostic criteria for lateral pelvic lymph node(LPLN)metastasis prediction based on LPLN short diameter in patients with and without preoperative treatment for rectal cancer.Methods:The clinicopathological data of rectal cancer patients with LPLN enlargement who underwent total mesorectal excision(TME)pluslateral pelvic lymph node dissection(LPLND)from January 2012 to December 2019 were retrospectively analyzed from the institutional database of the Chinese Lateral lymph Node Collaboration Group.Results:A total of 446 patients were enrolled,and all patients were divided into preoperative treatment and non-preoperative treatment group according to different preoperative treatment strategies.The proportion of pathological pCR/T 1(9.0%vs 2.7%,P=0.013)and N 0(41.9%vs 55.3%,P<0.001)in the preoperative treatment group were significant differences with the non-preoperative treatment group.In addition,the duration of operation was significantly longer in patients in the preoperative treatment group(300.7 vs 277.4 min,P=0.018).LPLN metastasis was pathologically diagnosed in 40(25.8%) and 78(26.8%) patients in the preoperative treatment group and the non-preoperative treatment group,respectively.Internal iliac lymph nodes were the most common LPLN metastases area in both patients with(16.1%) or without preoperative treatment(15.8%).The mean metastatic LPLN short diameter(1.0 vs 1.4 mm, P =0.015) and non-metastatic LPLN short diameter(0.6 vs 0.8 mm, P =0.005) of patients in the preoperative treatment group were significantly shorter than those in the non-preoperative treatment group.When 9 mm and 7 mm were used as cutoff values,AUC values were 0.817 and 0.745 respectively in the non-preoperative treatment group and the preoperative treatment group,showing good consistency. Conclusion: Patients receiving preoperative treatment and those not receiving preoperative treatment had the best ability to predict LPLN metastasis when the LPLN cut-off value was 7 mm and 9 mm,respectively.