The Effect of Lymph Nodes' Histologic Response on Survival Outcomes in Moroccan Patients with Rectal Cancer.

IF 1.6 Q4 ONCOLOGY
International Journal of Surgical Oncology Pub Date : 2020-01-06 eCollection Date: 2020-01-01 DOI:10.1155/2020/8406045
Ihsane El Otmani, Fatima El Agy, Mohammed El Abkari, Karim Ibn Majdoub Hassani, Khalid Mazaz, El Bachir Benjelloun, Khalid Ait Taleb, Touria Bouhafa, Zineb Benbrahim, Sidi Adil Ibrahimi, Laila Chbani
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引用次数: 0

Abstract

Prognosis for patients with locally advanced rectal cancer remains controversial. The purpose of this study was to elucidate possible association between therapeutic effect on lymph nodes (LNs) and patient prognosis. Overall, 149 patients with rectal cancer received preoperative radiotherapy in concomitance with chemotherapy or exclusive radiotherapy before rectal excision. Microscopic examination of formalin-fixed lymph nodes was assessed for therapeutic effect. The establishment of groups combined reaction tissue types of fibrosis, colloid, and necrosis after neoadjuvant treatment was assigned. The average age was 56.38 years, ranged between 22 and 88 years, 53% were female, and 47% were men, with a sex ratio of 1 : 12. In the present study, we noticed that after a median follow-up time of 40.67 months (0-83; SD: 21.1), overall survival was statistically significant depending on age groups. Kaplan-Meier analysis showed significant differences in the rate of patients with an age under 65 years (70.64%) versus those with an age over 85 years (36.5%) (p < 0.001). Also, the OS was statistically significant depending on therapeutic effect groups composed of 0TE (No Therapeutic effect), C+ (presence of only colloidal effect), F+ (presence of only fibrosis tissue), and ME+ (mixture of 2 or 3 types of therapeutic effect) group. Indeed, we observed a significantly higher OS rate in the ME + group (86%) compared with the OS rate of LNs group with no therapeutic effect (57%) (p=0.028). Additionally, there was a significant association between the presence of fibrosis on LNs and an extended delay of more than 8 weeks to neoadjuvant treatment completion and surgery. Our study indicates that the best patient prognosis could be predicted based on tumor presenting a best pathologic effect on lymph nodes, and that delaying surgery for more than 8 weeks to neoadjuvant treatment completion improves therapeutic response on LNs.

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淋巴结组织学反应对摩洛哥直肠癌患者生存结果的影响
局部晚期直肠癌患者的预后仍存在争议。本研究旨在阐明淋巴结的治疗效果与患者预后之间可能存在的关联。共有149名直肠癌患者在直肠切除术前接受了与化疗同时进行的术前放疗或单纯放疗。对福尔马林固定淋巴结进行显微镜检查,以评估治疗效果。将新辅助治疗后的纤维化、胶体和坏死反应组织类型进行分组。平均年龄为 56.38 岁,22 至 88 岁不等,女性占 53%,男性占 47%,性别比为 1 :12.在本研究中,我们注意到在中位随访时间为 40.67 个月(0-83;SD:21.1)后,不同年龄组的总生存率有显著的统计学差异。Kaplan-Meier 分析显示,65 岁以下患者(70.64%)与 85 岁以上患者(36.5%)的生存率存在显著差异(P < 0.001)。此外,OS 的统计意义还取决于治疗效果组,包括 0TE(无治疗效果)组、C+(仅存在胶体效果)组、F+(仅存在纤维化组织)组和 ME+(混合 2 或 3 种治疗效果)组。事实上,我们观察到 ME+ 组的 OS 率(86%)明显高于无治疗效果 LNs 组的 OS 率(57%)(P=0.028)。此外,LNs出现纤维化与新辅助治疗完成时间和手术时间延迟超过8周之间存在显著关联。我们的研究表明,根据肿瘤在淋巴结上的最佳病理效果可以预测患者的最佳预后,而将手术时间推迟到新辅助治疗结束后8周以上可以改善淋巴结的治疗反应。
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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