Prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.

IF 3.9 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Therapeutic Advances in Gastroenterology Pub Date : 2025-05-22 eCollection Date: 2025-01-01 DOI:10.1177/17562848251340494
Dakui Luo, Zhen Wang, Yufei Yang, Qingguo Li, Xinxiang Li
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引用次数: 0

Abstract

Background: A yield pathological T0 (ypT0) classification usually indicates the pathologically complete response of rectal cancer to neoadjuvant therapy. However, lymph node metastasis may still be present.

Objectives: In this study, we aimed to evaluate the prognostic value of residual lymph node status in patients with pathological T0 rectal cancer after neoadjuvant therapy.

Design: Retrospective cohort study.

Methods: Patients with locally advanced rectal cancer (LARC) who had undergone preoperative therapy and were pathologically classified as having ypT0 disease at Fudan University Shanghai Cancer Center between December 2012 and September 2022 were retrospectively analyzed. Uni- and multivariate analyses were performed to evaluate the effect of the residual lymph node status on disease-free survival (DFS) and overall survival (OS).

Results: A total of 457 patients had ypT0 disease; this included 413 patients with ypT0N0 and 44 with ypT0N1-2. Inadequate lymph node retrieval (<12, p = 0.002) and adenocarcinoma (p = 0.009) were more common in the ypT0N0 group than in the ypT0N1-2 group. The ypT0N1-2 group showed marginal evidence of a higher probability of elevated pretreatment carcinoembryonic antigen levels and adjuvant chemotherapy than the ypT0N0 group (p = 0.076 and p = 0.077, respectively). Patients with ypT0N0 had significantly better 5-year DFS than those with ypT0N1-2 (84.8% vs 68.4%, p = 0.016). However, no significant difference was observed in the 5-year OS between the two groups (93.9% vs 88.8%, p = 0.602). Multivariate analysis revealed that residual lymph node status was an independent prognostic factor for DFS (hazard ratio, 2.285; 95% confidence interval: 1.246-4.192, p = 0.008).

Conclusion: Residual lymph node metastasis may affect DFS, but not OS, in pathological T0 patients who receive neoadjuvant therapy followed by radical surgery for LARC.

病理性T0直肠癌患者新辅助治疗后残余淋巴结状态的预后价值。
背景:产率病理T0 (ypT0)分类通常表明直肠癌对新辅助治疗的病理完全反应。然而,淋巴结转移可能仍然存在。目的:在本研究中,我们旨在评估病理T0直肠癌患者新辅助治疗后淋巴结残留状态的预后价值。设计:回顾性队列研究。方法:回顾性分析2012年12月至2022年9月在复旦大学上海肿瘤中心接受术前治疗并病理分类为ypT0疾病的局部晚期直肠癌(LARC)患者。采用单因素和多因素分析来评估残留淋巴结状态对无病生存期(DFS)和总生存期(OS)的影响。结果:共有457例患者出现ypT0疾病;其中包括413例ypT0N0患者和44例ypT0N1-2患者。淋巴结切除不足(p = 0.002)和腺癌(p = 0.009)在ypT0N0组比ypT0N1-2组更常见。与ypT0N0组相比,ypT0N1-2组预处理癌胚抗原水平升高和辅助化疗的可能性更高(p = 0.076和p = 0.077)。ypT0N0组患者的5年DFS明显优于ypT0N1-2组(84.8% vs 68.4%, p = 0.016)。然而,两组5年OS无显著差异(93.9% vs 88.8%, p = 0.602)。多因素分析显示,淋巴结残余状态是DFS的独立预后因素(风险比,2.285;95%置信区间:1.246 ~ 4.192,p = 0.008)。结论:病理T0患者在接受新辅助治疗后根治性手术治疗LARC时,残留淋巴结转移可能影响DFS,但不影响OS。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Therapeutic Advances in Gastroenterology
Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
6.70
自引率
2.40%
发文量
103
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.
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