Clinicopathological Characteristics and Survival Prognosis Analysis of 102 Rectal Cancer Patients with Lateral Pelvic Lymph Node Metastases
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摘要:目的
探讨侧方淋巴结清扫术（LPLND）在侧方淋巴结（LPLN）转移患者中的治疗效果及预后意义。
方法回顾性分析2012年1月—2020年12月在中国医学科学院肿瘤医院和北京大学第一医院行全直肠系膜切除术（TME）联合LPLND术后病理证实LPLN转移的直肠癌患者的临床病理资料。探讨LPLN转移患者临床病理特点与转移规律，同时进行预后分析。
结果共纳入102例病理证实LPLN转移的直肠癌患者。LPLN常见转移部位依次为髂内淋巴结（n=68, 66.7%）、闭孔淋巴结（n=44, 43.1%）和髂总/髂外淋巴结（n=12, 11.8%）。10例（9.8%）患者出现双侧LPLN转移，平均LPLN转移数量为2.2±2.4，其中16例（15.7%）患者LPLN转移数量≥2。LPLN转移至髂外/髂总淋巴结的患者3年总体生存率（OS）（66.8% vs. 7.7%, P < 0.001）与无瘤生存率（DFS）（39.1% vs. 10.5%, P=0.012）明显低于转移至髂内/闭孔淋巴结转移的患者。多因素分析显示LPLN转移至髂外/髂总是影响OS（HR=3.53; 95%CI: 1.50~8.31; P=0.004）和DFS（HR=2.40; 95%CI: 1.05~5.47; P=0.037）的共同独立危险因素。
结论LPLN转移主要位于髂内血管与闭孔区域。转移至髂外或髂总淋巴结患者的生存预后无法通过LPLND改善，全身性综合治疗往往是此类患者的最佳治疗选择。
Abstract:ObjectiveTo investigate the therapeutic effect and prognostic significance of lateral lymph node dissection (LPLND) in patients with lateral lymph node (LPLN) metastasis.
MethodsThe clinicopathological data of rectal cancer patients who underwent total mesorectal excision (TME) combined with LPLND and pathologically confirmed as LPLN metastasis after operation were retrospectively analyzed. The clinicopathological characteristics and metastasis rules of patients with LPLN metastasis were discussed, and the survival prognosis after LPLND was analyzed.
ResultsA total of 102 rectal cancer patients with pathologically confirmed LPLN metastasis were included. The common sites of LPLN metastasis were internal iliac vessels lymph nodes (n=68, 66.7%), followed by obturator lymph nodes (n=44, 43.1%), and common iliac vessels or external iliac vessels lymph nodes (n=12, 11.8%). There were 10 patients (9.8%) with bilateral LPLN metastases, and the mean number of LPLN metastases was 2.2±2.4, among which 16 patients (15.7%) had LPLN metastases number≥2. The 3-year OS (66.8% vs. 7.7%, P < 0.001) and DFS (39.1% vs. 10.5%, P=0.012) of patients with LPLN metastases to the external iliac or common iliac lymph node were significantly lower than those with metastases to the internal iliac or obturator lymph node. The multivariate analysis showed that LPLN metastasis to external iliac or common iliac lymph node was an independent risk factor both for OS (HR=3.53; 95%CI: 1.50-8.31; P=0.004) and DFS (HR=2.40; 95%CI: 1.05-5.47; P=0.037).
ConclusionLPLN mainly metastasizes to the internal iliac or obturator lymph node areas. The survival of patients with metastasis to the external iliac or common iliac lymph node cannot be improved by LPLND, and thus systemic comprehensive treatment is often the optimal treatment option.
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Competing interests: The authors declare that they have no competing interests.作者贡献：周思成、武海峰：研究设计、实验实施、论文撰写及修改潘雨婷、云红、曹少木、聂红霞：数据收集与统计学分析兴伟：研究设计、写作指导与文章修改梁建伟：研究设计
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图 1 102例直肠癌侧方淋巴结转移患者的总体生存曲线(A)无瘤生存曲线(B)
Figure 1 Overall survival curve(A) and disease-free survival curve(B) of 102 rectal cancer patients with lateral pelvic lymph node metastases
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图 2 侧方淋巴结转移转移至髂内/闭孔和髂总/髂外患者的总体生存曲线(A)与无瘤生存曲线(B)
Figure 2 Overall survival curve(A) and disease-free survival curve(B) of patients with lateral pelvic lymph node metastasis to external/common iliac lymph nodes or internal iliac/obturator lymph node
表 1 102例直肠癌侧方淋巴结转移患者的临床病理资料(n(%))
Table 1 Clinicopathological data of 102 rectal cancer patients with lateral pelvic lymph node metastases (n(%))
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表 2 102例直肠癌侧方淋巴结转移患者的预后单因素及多因素Cox回归分析
Table 2 Univariate and multivariate Cox regression analyses for prognosis of 102 rectal cancer patients with lateral pelvic lymph node metastases
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