Annals of surgery · 2024
Association of Lateral Pelvic Lymph Nodes with Disease Recurrence and Organ Preservation in Patients with Distal Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка NIH: внешняя программаНазвание и аннотация: Перевод пока не подготовлен
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Beets Nathalie R A, Verheij Floris S, Williams Hannah, Omer Dana M, Lin Sabrina T, Qin Li-Xuan, Beets Geerard L, Beets-Tan Regina G H, Wei Iris H, Widmar Maria, Pappou Emmanouil P, Weiser Martin R, Nash Garrett M, Smith J Joshua, Paty Philip B, Miranda Joao, Kim Tae-Hyung, Gollub Marc J, Garcia-Aguilar Julio
Аннотация
OBJECTIVE: To assess the significance of enlarged lateral lymph nodes (LLN) for disease recurrence, metastasis, and organ preservation in patients with rectal cancer.
BACKGROUND: Optimal treatment of rectal adenocarcinoma involving LLN is subject to debate.
METHODS: A post hoc analysis of the Organ Preservation in Rectal Adenocarcinoma trial, a multicenter study of patients with rectal cancer treated with total neoadjuvant therapy (TNT) followed by total mesorectal excision or watch-and-wait management. We analyzed the association of visible LLN (LLN+), LLN ≥7 mm (short axis) on baseline magnetic resonance imaging (MRI), and LLN ≥4 mm on restaging MRI with recurrence, metastasis, and rectum preservation.
RESULTS: At baseline, 57 out of 324 (18%) patients had LLN+. In 30 (53%) of 57 patients with LLN+ on baseline MRI, the LLN disappeared after TNT. Disease recurrence in LLN was rare (3.5% of patients with LLN+ and 0.4% of patients with LLN-). All patients with recurrence in LLN also had distant metastasis. The rate of organ preservation was significantly lower in patients with LLN ≥4 mm on restaging MRI ( P = 0.013). We found no significant differences in rates of local recurrence or metastasis between patients with LLN+ versus LLN- and in patients with LLN ≥7 versus <7 mm on baseline MRI. LLN dissection was performed in 3 patients; 2 of them died of distant metastasis.
CONCLUSIONS: LLN involvement is not associated with disease recurrence or metastasis, but persistence of LLN ≥4 mm after TNT is negatively associated with rectum preservation in patients with locally advanced rectal cancer treated with TNT. Dissection of lateral nodes likely benefits few patients.
BACKGROUND: Optimal treatment of rectal adenocarcinoma involving LLN is subject to debate.
METHODS: A post hoc analysis of the Organ Preservation in Rectal Adenocarcinoma trial, a multicenter study of patients with rectal cancer treated with total neoadjuvant therapy (TNT) followed by total mesorectal excision or watch-and-wait management. We analyzed the association of visible LLN (LLN+), LLN ≥7 mm (short axis) on baseline magnetic resonance imaging (MRI), and LLN ≥4 mm on restaging MRI with recurrence, metastasis, and rectum preservation.
RESULTS: At baseline, 57 out of 324 (18%) patients had LLN+. In 30 (53%) of 57 patients with LLN+ on baseline MRI, the LLN disappeared after TNT. Disease recurrence in LLN was rare (3.5% of patients with LLN+ and 0.4% of patients with LLN-). All patients with recurrence in LLN also had distant metastasis. The rate of organ preservation was significantly lower in patients with LLN ≥4 mm on restaging MRI ( P = 0.013). We found no significant differences in rates of local recurrence or metastasis between patients with LLN+ versus LLN- and in patients with LLN ≥7 versus <7 mm on baseline MRI. LLN dissection was performed in 3 patients; 2 of them died of distant metastasis.
CONCLUSIONS: LLN involvement is not associated with disease recurrence or metastasis, but persistence of LLN ≥4 mm after TNT is negatively associated with rectum preservation in patients with locally advanced rectal cancer treated with TNT. Dissection of lateral nodes likely benefits few patients.