Upfront surgery, neoadjuvant chemoradiotherapy, or neoadjuvant chemotherapy for rectal cancer with lateral lymph node metastasis: A multicenter MRI and lateral lymph node dissection study

IF 2.9 4区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Annals of Gastroenterological Surgery Pub Date : 2024-10-16 DOI:10.1002/ags3.12873

Takuya Miura, Kazushige Kawai, Hiromasa Fujita, Shinsuke Kazama, Hideki Ueno, Yusuke Kinugasa, Kazuhiro Sakamoto, Hirotoshi Kobayashi, Kenichi Hakamada, Yoichi Ajioka

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Abstract

Aim

The purpose was to clarify the oncological outcomes of rectal cancer (RC) with lateral lymph node metastasis (LLNM) on high-resolution MRI (HRMRI), considering preoperative treatments.

Methods

Two hundred and twelve patients, from 13 hospitals, diagnosed with RC with lateral lymph node dissection (LLND), between 2017 and 2019, were prospectively registered. LLNM was defined as a short-axis size ≥5 mm. Ultimately, this study included 102 patients. Upfront surgery (Upfront), chemoradiotherapy (CRT), and neoadjuvant chemotherapy (NAC) were performed at each institution's discretion.

Results

Sixty-six (64.7%) had mesorectal fascia (MRF) involvement, 35 (34.3%) had extramural venous invasion, and 33 (32.4%) had bilateral LLNMs. A positive radial margin (RM1) was observed in nine patients (8.8%), and 35 (34.3%) had pathological LLNM (pLLNM). Overall, 3-year relapse-free survival (3yRFS) and local recurrence-free survival (3yLRFS) were 69.6% and 92.9%. Upfront 3yRFS (N = 54), CRT (N = 23) and NAC (N = 25) constituted 62.9%, 82.6%, and 72.0%; 3yLRFS was 92.4%, 100%, and 88.0%. RM1 and pLLNM were significantly associated with LRFS (RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%; pLLNM negative vs. positive, 97.0% vs. 84.7%). 3yRFS Upfront non-MRF (N = 21), post CRT non-MRF (N = 15), and post NAC non-MRF (N = 14) were 61.9%, 86.7%, and 100%; 3yLRFS was 90.2%, 100%, and 100%.

Conclusions

Good local control of Upfront LLND for RC with LLNM was shown, but multidisciplinary treatments were required. CRT followed by surgery was preferable for RC with LLNM, but a radiation-sparing strategy is promising for post NAC non-MRF.

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直肠癌伴外侧淋巴结转移的术前手术、新辅助放化疗或新辅助化疗：一项多中心MRI和外侧淋巴结清扫研究

目的探讨考虑术前治疗的高分辨率MRI （HRMRI）对直肠癌（RC）伴外侧淋巴结转移（LLNM）的预后。方法对2017 - 2019年13家医院诊断为RC合并侧淋巴结清扫（LLND）的212例患者进行前瞻性登记。LLNM定义为短轴尺寸≥5mm。最终，这项研究纳入了102名患者。术前手术（Upfront）、放化疗（CRT）和新辅助化疗（NAC）由各机构自行决定。结果直肠系膜筋膜（MRF）受累66例（64.7%），外静脉侵犯35例（34.3%），双侧LLNMs 33例（32.4%）。桡骨缘（RM1）阳性9例（8.8%），病理性LLNM (pLLNM) 35例（34.3%）。总体而言，3年无复发生存率（3yRFS）和局部无复发生存率（3yLRFS）分别为69.6%和92.9%。前期3yRFS （N = 54）、CRT （N = 23）和NAC （N = 25）分别占62.9%、82.6%和72.0%；3yLRFS分别为92.4%、100%和88.0%。RM1和pLLNM与LRFS显著相关(RM0 vs. RM1, 3yLRFS 96.7% vs. 50.0%；pLLNM阴性vs阳性，97.0% vs 84.7%)。前期非mrf （N = 21）、CRT后非mrf （N = 15）、NAC后非mrf （N = 14）分别为61.9%、86.7%、100%；3yLRFS分别为90.2%、100%和100%。结论对于合并LLNM的RC患者，前期LLND的局部控制良好，但需要多学科治疗。对于伴有LLNM的RC， CRT后手术是可取的，但对于NAC后非mrf，放射节约策略是有希望的。

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