Background: The purpose of this study was to evaluate the long-term oncological progression pattern of locally advanced rectal cancer patients with post-neoadjuvant nodal metastatic disease (ypN+) and correlate potential prognostic features associated with proven radiochemoresistant nodal biology. Methods: Individual patient data (100 variables) from a 20-year consecutive single-institution multidisciplinary experience (1995–2015), delivering multimodal therapy to rectal cancer patient candidates for radical treatment, including a neoadjuvant component and surgical resection with or without intraoperative radiotherapy followed by optional adjuvant chemotherapy. The ypN+ disease data was registered in the context of initial staging categories post-neoadjuvant T status (ypT). Results: Data on 487 patients showed histologically confirmed diagnoses of metastatic nodal disease in 108 specimens (ypN+, 22.1). There was a significant age difference (p =0.009) between the ypN groups: age ≥ 65 was 57.6% in pN0 and 43.5% in ypN+ and patients aged < 65 constituted 42.4% of pN0 and 56.5% of ypN+. According to the clinical stage there were statistically significant differences (p =0.001) in the categories’ distribution: ypN+ patients 10.8% were stage II and 89.2% were stage III. Univariant analysis on outcome variables showed statistically significant differences in overall survival at 7 years (63.8% vs. 55.7%,p= 0.016) disease-free survival (DFS) (78% vs. 53.8%,p= 0.000) and local recurrence-free survival (LRFS) (93.6% vs. 84%,p =0.002). Conclusions: The presence of nodal metastases (ypN+) after neoadjuvant therapy containing long-course pelvic irradiation severely impacts the long-term outcome for patients with locally advanced rectal cancer and correlates with multiple clinical and therapeutic variable metrics. Implementation of local and systemic therapies should be adapted and intensified in relation to the finding of ypN+ category in surgical specimens.
背景：本研究旨在评估新辅助治疗后淋巴结转移（ypN+）的局部晚期直肠癌患者的长期肿瘤进展模式，并分析与已证实的放化疗抵抗性淋巴结生物学相关的潜在预后特征。方法：数据来源于一家机构连续20年（1995-2015年）的多学科诊疗经验，收集了计划接受根治性治疗（包括新辅助治疗、手术切除、酌情联合术中放疗及辅助化疗）的直肠癌患者的个体数据（100个变量）。ypN+疾病数据根据新辅助治疗后T分期（ypT）的初始分期类别进行登记。结果：487例患者数据显示，108例标本（ypN+，22.1%）经组织学确诊为淋巴结转移性疾病。ypN组间存在显著年龄差异（p=0.009）：pN0组中年龄≥65岁者占57.6%，ypN+组中占43.5%；pN0组中年龄<65岁者占42.4%，ypN+组中占56.5%。根据临床分期，各分期分布存在统计学显著差异（p=0.001）：ypN+患者中II期占10.8%，III期占89.2%。对结局变量的单因素分析显示，7年总生存率（63.8% vs. 55.7%，p=0.016）、无病生存率（78% vs. 53.8%，p=0.000）和局部无复发生存率（93.6% vs. 84%，p=0.002）均存在统计学显著差异。结论：包含长程盆腔放疗的新辅助治疗后出现淋巴结转移（ypN+）严重影响局部晚期直肠癌患者的长期预后，并与多项临床及治疗变量指标相关。应根据手术标本中ypN+类别的发现，调整并强化局部和全身治疗方案。
肿瘤(癌症)患者之家