Background/Objectives: The metastatic patterns of apical lymph node (ALN) in rectal and sigmoid colon cancer are currently unclear, and there is no consensus on the indications for dissection of ALN. This study aimed to analyze the impact of ALN metastasis on prognosis, determine the metastatic patterns of ALN and provide evidence for indications of ALN dissection in rectal and sigmoid colon cancer.Methods: In this multicenter, retrospective cohort study, patients from five centers with stage I-III rectal or sigmoid colon cancer who underwent laparoscopic radical surgery with ALN dissection without neoadjuvant treatment from January 2015 to December 2019 were enrolled.Results: Among 2809 patients, the positive rate of ALN was 1.9%. The 5-year overall survival and cancer-specific survival rate for patients with metastatic ALN were 37.5% and 41.0%, respectively. ALN metastasis was the independent risk factor for poor prognosis. Tumor size ≥5 cm (OR = 2.32, 95% CI: 1.30–4.13,p= 0.004), signet ring cell cancer/mucinous adenocarcinoma (vs. poor differentiated adenocarcinoma, OR = 0.19, 95% CI: 0.08–0.45,p< 0.001; vs. moderate to well differentiated adenocarcinoma, OR = 0.22, 95% CI: 0.11–0.42,p< 0.001), T4 stage (OR = 1.93, 95% CI: 1.05–3.55,p= 0.034), N2 stage (OR = 8.86, 95% CI: 4.45–17.65,p< 0.001) and radiologic evidence of extramural venous invasion (OR = 1.88, 95% CI: 1.03–3.42,p= 0.040) were independent risk factors for ALN metastasis. The nomogram model developed by these factors achieved a good predictive performance.Conclusions: This research offered insights into the incidence, risk factors, and prognostic significance of apical lymph node metastasis in cases of rectal and sigmoid colon cancer. Additionally, the study furnished empirical support for the criteria guiding ALN dissection. Furthermore, a pragmatic risk assessment model was developed to predict ALN metastasis.
背景/目的：目前直肠癌和乙状结肠癌中顶端淋巴结（ALN）的转移模式尚不明确，且关于ALN清扫的指征尚未达成共识。本研究旨在分析ALN转移对预后的影响，确定ALN的转移模式，并为直肠癌和乙状结肠癌中ALN清扫的指征提供依据。方法：在这项多中心回顾性队列研究中，纳入了2015年1月至2019年12月期间来自五个中心的I-III期直肠癌或乙状结肠癌患者，这些患者均接受了腹腔镜根治性手术及ALN清扫，且未接受新辅助治疗。结果：在2809例患者中，ALN阳性率为1.9%。ALN转移患者的5年总生存率和癌症特异性生存率分别为37.5%和41.0%。ALN转移是预后不良的独立危险因素。肿瘤大小≥5厘米（OR = 2.32，95% CI：1.30–4.13，p = 0.004）、印戒细胞癌/黏液腺癌（与低分化腺癌相比，OR = 0.19，95% CI：0.08–0.45，p < 0.001；与中高分化腺癌相比，OR = 0.22，95% CI：0.11–0.42，p < 0.001）、T4分期（OR = 1.93，95% CI：1.05–3.55，p = 0.034）、N2分期（OR = 8.86，95% CI：4.45–17.65，p < 0.001）以及影像学证据显示壁外血管侵犯（OR = 1.88，95% CI：1.03–3.42，p = 0.040）是ALN转移的独立危险因素。基于这些因素构建的列线图模型具有良好的预测性能。结论：本研究揭示了直肠癌和乙状结肠癌中顶端淋巴结转移的发生率、危险因素及其预后意义。此外，研究为ALN清扫的指征提供了实证支持，并构建了一个实用的风险评估模型用于预测ALN转移。
肿瘤(癌症)患者之家