|Table of Contents|

Explore the cutoff value of lateral pelvic lymph node short diameter for preoperative prediction of lateral pelvic lymph node metastasis of rectal cancer based on MRI

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 15
Page:
2796-2801
Research Field:
Publishing date:

Info

Title:
Explore the cutoff value of lateral pelvic lymph node short diameter for preoperative prediction of lateral pelvic lymph node metastasis of rectal cancer based on MRI
Author(s):
FENG Hao1; REN Yining1; LI Guolei1; LIANG Jianwei2; XING Wei1
1.General Surgery Department,Hebei Provincial Hospital of Traditional Chinese Medicine，Hebei Shijiazhuang 050000,China;2.Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China.
Keywords:
lateral pelvic lymph node dissection; lateral pelvic lymph node metastasis; neoadjuvant therapy; rectal cancer; prediction
PACS:
R735.3
DOI:
10.3969/j.issn.1672-4992.2024.15.016
Abstract:
Objective:To investigate the diagnostic criteria for lateral pelvic lymph node(LPLN) metastasis prediction based on LPLN short diameter in patients with and without preoperative treatment for rectal cancer.Methods:The clinicopathological data of rectal cancer patients with LPLN enlargement who underwent total mesorectal excision(TME) pluslateral pelvic lymph node dissection(LPLND) from January 2012 to December 2019 were retrospectively analyzed from the institutional database of the Chinese Lateral lymph Node Collaboration Group.Results:A total of 446 patients were enrolled,and all patients were divided into preoperative treatment and non-preoperative treatment group according to different preoperative treatment strategies.The proportion of pathological pCR/T1(9.0% vs 2.7%,P=0.013) and N0(41.9% vs 55.3%,P<0.001) in the preoperative treatment group were significant differences with the non-preoperative treatment group.In addition,the duration of operation was significantly longer in patients in the preoperative treatment group(300.7 vs 277.4 min,P=0.018).LPLN metastasis was pathologically diagnosed in 40(25.8%) and 78(26.8%) patients in the preoperative treatment group and the non-preoperative treatment group,respectively.Internal iliac lymph nodes were the most common LPLN metastases area in both patients with(16.1%) or without preoperative treatment(15.8%).The mean metastatic LPLN short diameter(1.0 vs 1.4 mm,P=0.015) and non-metastatic LPLN short diameter(0.6 vs 0.8 mm,P=0.005) of patients in the preoperative treatment group were significantly shorter than those in the non-preoperative treatment group.When 9 mm and 7 mm were used as cutoff values,AUC values were 0.817 and 0.745 respectively in the non-preoperative treatment group and the preoperative treatment group,showing good consistency.Conclusion:Patients receiving preoperative treatment and those not receiving preoperative treatment had the best ability to predict LPLN metastasis when the LPLN cut-off value was 7 mm and 9 mm,respectively.

References:

［1］韩晓东,李衍,武亚超,等.全直肠系膜切除术联合侧方淋巴结清扫术治疗中低位直肠癌侧方淋巴结转移的疗效［J］.现代肿瘤医学,2023,31(24):4576-4581. HAN XD,LI Y,WU YC,et al.The efficacy of total mesorecfal excision combined with lateral lymph node dissection in the treatment of lateral lymph node metastasis in middle and low rectal cancer［J］.Modern Oncology,2023,31(24):4576-4581.
［2］FUJITA S,MIZUSAWA J,KANEMITSU Y,et al.Mesorectal excision with or without lateral lymph node dissection for clinical stage Ⅱ/Ⅲ lower rectal cancer(JCOG0212):A multicenter,randomized controlled,noninferiority trial［J］.Ann Surg,2017,266(2):201-207.
［3］KANEMITSU Y,KOMORI K,SHIDA D,et al.Potential impact of lateral lymph node dissection(LLND) for low rectal cancer on prognoses and local control:A comparison of 2 high-volume centers in Japan that employ different policies concerning LLND［J］.Surgery,2017,162(2):303-314.
［4］FUJITA S,AKASU T,MIZUSAWA J,et al.Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage Ⅱ or stage Ⅲ lower rectal cancer(JCOG0212):Results from a multicentre,randomised controlled,non-inferiority trial［J］.Lancet Oncol,2012,13(6):616-621.
［5］YANG X,GU C,HU T,et al.Indications and oncological outcomes of selective dissection for clinically suspected lateral lymph node metastasis in patients with rectal cancer based on pretreatment imaging［J］.Tech Coloproctol,2021,25(4):425-437.
［6］ZHOU S,JIANG Y,PEI W,et al.Neoadjuvant chemoradiotherapy followed by lateral pelvic lymph node dissection for rectal cancer patients:A retrospective study of its safety and indications［J］.J Surg Oncol,2021,124(3):354-360.
［7］INOUE Y,SAIGUSA S,HIRO J,et al.Clinical significance of enlarged lateral pelvic lymph nodes before and after preoperative chemoradiotherapy for rectal cancer［J］.Mol Clin Oncol,2016,4(6):994-1002.
［8］ZHOU S,YANG Y,LOU Z,et al.Establishing and validating predictive nomograms for lateral pelvic lymph node metastasis in patients with rectal cancer based on radiologic factors and clinicopathologic characteristics［J］.Eur J Surg Oncol,2023,49(4):747-754.
［9］WEISER MR.AJCC 8th edition:Colorectal cancer［J］.Ann Surg Oncol,2018,25(6):1454-1455.
［10］HASHIGUCHI Y,MURO K,SAITO Y,et al.Japanese Society for Cancer of the Colon and Rectum(JSCCR) guidelines 2019 for the treatment of colorectal cancer［J］.Int J Clin Oncol,2020,25(1):1-42.
［11］NAKANISHI R,AKIYOSHI T,TODA S,et al.Radiomics approach outperforms diameter criteria for predicting pathological lateral lymph node metastasis after neoadjuvant(chemo) radiotherapy in advanced low rectal cancer［J］.Ann Surg Oncol,2020,27(11):4273-4283.
［12］HAZEN SJA,SLUCKIN TC,KONISHI T,et al.Lateral lymph node dissection in rectal cancer:State of the art review［J］.Eur J Surg Oncol,2022,48(11):2315-2322.
［13］KAWAI K,SHIRATORI H,HATA K,et al.Optimal size criteria for lateral lymph node dissection after neoadjuvant chemoradiotherapy for rectal cancer［J］.Dis Colon Rectum,2021,64(3):274-283.
［14］BAI DL,LI Q.Study on the therapeutic effect of laparoscopic surgery after neoadjuvant chemoradiotherapy［J］.Chinese J Frontiers Med Sci,2016,8:50-53.
［15］OGURA A,KONISHI T,BEETS GL,et al.Lateral node study consortium.Lateral nodal features on restaging magnetic resonance imaging associated with lateral local recurrence in low rectal cancer after neoadjuvant chemoradiotherapy or radiotherapy［J］.JAMA Surg,2019,154(9):e192172.

Memo

Memo:
河北省2022年度医学科学研究课题计划(编号：20220077)
Last Update: 2024-06-28