Erschienen in:
01.07.2014 | Colorectal Cancer
Neoadjuvant Chemoradiotherapy Affects the Indications for Lateral Pelvic Node Dissection in Mid/Low Rectal Cancer with Clinically Suspected Lateral Node Involvement: A Multicenter Retrospective Cohort Study
verfasst von:
Heung-Kwon Oh, MD, Sung-Bum Kang, MD, PhD, Sung-Min Lee, MD, Soo Young Lee, MD, Myoung Hun Ihn, MD, Duck-Woo Kim, MD, PhD, Ji Hoon Park, MD, Young Hoon Kim, MD, PhD, Kyung Ho Lee, MD, PhD, Jae-Sung Kim, MD, PhD, Jin Won Kim, MD, Jee Hyun Kim, MD, PhD, Tae-Young Chang, MD, Sung-Chan Park, MD, PhD, Dae Kyung Sohn, MD, PhD, Jae Hwan Oh, MD, PhD, Ji Won Park, MD, Seung-Bum Ryoo, MD, Seung-Yong Jeong, MD, PhD, Kyu Joo Park, MD, PhD
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 7/2014
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Abstract
Background
Although lateral pelvic node dissection (LPND) is recommended for rectal cancer with clinically metastatic lateral pelvic lymph nodes (LPNs), LPNs may respond to neoadjuvant chemoradiotherapy (nCRT). Our aim was to determine the optimal indication for LPND after nCRT for mid/low rectal cancer.
Methods
Of 2,263 patients with clinical stage II/III mid/low rectal cancer who were managed at three tertiary referral hospitals, 66 patients underwent curative surgery including LPND after nCRT were included in this study. Risk factors for LPN metastasis were retrospectively analyzed and oncologic outcomes determined according to LPN response to nCRT.
Results
Persistent LPNs greater than 5 mm on post-nCRT magnetic resonance imaging were significantly associated with residual tumor metastasis, unlike responsive LPN after nCRT (short-axis diameter ≤5 mm) (pathologically, 61.1 % [22 of 36] vs. 0 % [0 of 30], P < 0.001). Multivariable analysis revealed post-nCRT LPN size as a significant and independent risk factor for LPN metastasis (odds ratio 2.390; 95 % confidence interval 1.104–4.069). Over a median follow-up of 39.3 months, the recurrence rate was lower in patients with responsive nodes than in patients with persistent nodes (20 % [6 of 30] vs. 47.2 % [17 of 36], P = 0.012). The 5-year overall survival and 5-year disease-free survival rates were lower in patients with persistent LPN than in patients with responsive LPN (44.6 % vs. 77.1 %, P = 0.034; 33.7 % vs. 72.5 %, P = 0.011, respectively).
Conclusions
In mid/low rectal cancer with clinically metastatic LPNs, the decision to perform LPND should be based on the LPN response to nCRT.