Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes.
Journal
The British journal of surgery
ISSN: 1365-2168
Titre abrégé: Br J Surg
Pays: England
ID NLM: 0372553
Informations de publication
Date de publication:
12 03 2021
12 03 2021
Historique:
received:
18
05
2020
revised:
06
07
2020
accepted:
29
08
2020
entrez:
12
3
2021
pubmed:
13
3
2021
medline:
29
4
2021
Statut:
ppublish
Résumé
In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes.Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.
Sections du résumé
BACKGROUND
In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes.
METHODS
Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response.
RESULTS
More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease.
CONCLUSION
Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes.Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.
Identifiants
pubmed: 33711144
pii: 6114692
doi: 10.1093/bjs/znaa009
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
205-213Investigateurs
M Kusters
(M)
J Tuynman
(J)
R Hompes
(R)
T Akiyoshi
(T)
T Konishi
(T)
G A P Nieuwenhuijzen
(GAP)
H J T Rutten
(HJT)
D P Schaap
(DP)
H Iversen
(H)
A Martling
(A)
C Suzuki
(C)
E Meershoek-Klein-Kranenbarg
(E)
A Ogura
(A)
H Putter
(H)
C J H van de Velde
(CJH)
J Garcia-Aguilar
(J)
M J Gollub
(MJ)
T Aiba
(T)
A Ogura
(A)
K Uehara
(K)
A G J Aalbers
(AGJ)
G L Beets
(GL)
R G H Beets-Tan
(RGH)
M Maas
(M)
M Betts
(M)
C Cunningham
(C)
H X Lee
(HX)
J Moore
(J)
T Sammour
(T)
M Thomas
(M)
T Wells
(T)
P Lee
(P)
M J Solomon
(MJ)
M H Choi
(MH)
M K Kim
(MK)
I K Lee
(IK)
S N Oh
(SN)
D D Won
(DD)
Y Hanaoka
(Y)
H Kuroyanagi
(H)
S Toda
(S)
K Tomizawa
(K)
H Rutten
(H)
K G Brown
(KG)
P Lee
(P)
M J Solomon
(MJ)
Informations de copyright
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.