{"title":"Post-hoc analysis of clinicopathological factors affecting lateral lymph node metastasis based on STELLAR study for rectal cancer","authors":"","doi":"10.1016/j.radonc.2024.110512","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><p>In post-hoc analyses of phase<!--> <!-->III randomized controlled study<!--> <!-->(STELLAR), to analyze<!--> <!-->the prognostic impact of<!--> <!-->lateral pelvic lymph node (LPLN)<!--> <!-->metastasis in locally advanced rectal cancer (LARC).</p></div><div><h3>Methods</h3><p>LPLN metastasis was defined as a short diameter > 7 mm on magnetic resonance imaging (MRI).<!--> <!-->The study<!--> <!-->included 591 patients with LARC.<!--> <!-->All patients received neoadjuvant (chemo)radiotherapy combined with<!--> <!-->radical resection.</p></div><div><h3>Results</h3><p>Among 591 patients, 99 (16.8 %) were diagnosed with LPLN metastasis, mostly with unilateral metastasis (79.8 %), with internal iliac lymph node metastasis being more common (81.8 %).<!--> <!-->Significant differences were found among with and without LPLN metastasis in rectal segmentation (P=0.001),<!--> <!-->N disease (P<0.001), mesenteric LN metastasis or not (P=0.030). The median follow-up time<!--> <!-->was 34.0 months, three-year disease-free survival (DFS),<!--> <!-->overall survival (OS), and<!--> <!-->metastasis-free survival (MFS)<!--> <!-->were significantly lower in LPLN metastatic<!--> <!-->group than those in LPLN non-metastatic<!--> <!-->group (51.4 % vs. 68.2 %, P<0.001; 71.8 % vs. 84.2 %, P=0.006; 60.8 % vs. 80.1 %,<!--> <!-->P<0.001), respectively; while there were no significant differences in locoregional recurrence<!--> <!-->(11.4 % vs. 8.5 %, P=0.564). Multivariate analysis found that LPLN metastasis was an independent prognostic factor affecting DFS (P=0.005), OS (P=0.036),<!--> <!-->MFS (P=0.001).<!--> <!-->No significantly survival benefit was observed for the short-term radiotherapy based total neoadjuvant therapy compared to long-term concurrent chemoradiotherapy.</p></div><div><h3>Conclusions</h3><p>LPLN metastasis observed by<!--> <!-->MRI should be considered in LARC patients, especially in populations with low<!--> <!-->rectal cancer, N2 disease, and mesenteric LN metastasis. LPLN metastasis diagnosed by MRI is a significant and independent risk factor and is associated with worse DFS, OS, MFS.</p></div>","PeriodicalId":21041,"journal":{"name":"Radiotherapy and Oncology","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016781402403490X/pdfft?md5=eb2b10c6528aa4b78827cd9a7e71de50&pid=1-s2.0-S016781402403490X-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiotherapy and Oncology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S016781402403490X","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose
In post-hoc analyses of phase III randomized controlled study (STELLAR), to analyze the prognostic impact of lateral pelvic lymph node (LPLN) metastasis in locally advanced rectal cancer (LARC).
Methods
LPLN metastasis was defined as a short diameter > 7 mm on magnetic resonance imaging (MRI). The study included 591 patients with LARC. All patients received neoadjuvant (chemo)radiotherapy combined with radical resection.
Results
Among 591 patients, 99 (16.8 %) were diagnosed with LPLN metastasis, mostly with unilateral metastasis (79.8 %), with internal iliac lymph node metastasis being more common (81.8 %). Significant differences were found among with and without LPLN metastasis in rectal segmentation (P=0.001), N disease (P<0.001), mesenteric LN metastasis or not (P=0.030). The median follow-up time was 34.0 months, three-year disease-free survival (DFS), overall survival (OS), and metastasis-free survival (MFS) were significantly lower in LPLN metastatic group than those in LPLN non-metastatic group (51.4 % vs. 68.2 %, P<0.001; 71.8 % vs. 84.2 %, P=0.006; 60.8 % vs. 80.1 %, P<0.001), respectively; while there were no significant differences in locoregional recurrence (11.4 % vs. 8.5 %, P=0.564). Multivariate analysis found that LPLN metastasis was an independent prognostic factor affecting DFS (P=0.005), OS (P=0.036), MFS (P=0.001). No significantly survival benefit was observed for the short-term radiotherapy based total neoadjuvant therapy compared to long-term concurrent chemoradiotherapy.
Conclusions
LPLN metastasis observed by MRI should be considered in LARC patients, especially in populations with low rectal cancer, N2 disease, and mesenteric LN metastasis. LPLN metastasis diagnosed by MRI is a significant and independent risk factor and is associated with worse DFS, OS, MFS.
期刊介绍:
Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.