谢福平, 高昱, 林振宇, 肖帆, 蔡耀元, 邱兴烽. 局部进展期直肠癌新辅助短程放化疗联合免疫治疗后区域淋巴结的转归[J]. 中国肿瘤临床, 2023, 50(24): 1271-1274. DOI: 10.12354/j.issn.1000-8179.2023.20231033
引用本文: 谢福平, 高昱, 林振宇, 肖帆, 蔡耀元, 邱兴烽. 局部进展期直肠癌新辅助短程放化疗联合免疫治疗后区域淋巴结的转归[J]. 中国肿瘤临床, 2023, 50(24): 1271-1274. DOI: 10.12354/j.issn.1000-8179.2023.20231033
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Fuping Xie, Yu Gao, Zhenyu Lin, Fan Xiao, Yaoyuan Cai, Xingfeng Qiu. Regional lymph node regression following neoadjuvant short-course chemoradiotherapy combined with immunotherapy in locally advanced rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(24): 1271-1274. DOI: 10.12354/j.issn.1000-8179.2023.20231033
Citation: Fuping Xie, Yu Gao, Zhenyu Lin, Fan Xiao, Yaoyuan Cai, Xingfeng Qiu. Regional lymph node regression following neoadjuvant short-course chemoradiotherapy combined with immunotherapy in locally advanced rectal cancer[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2023, 50(24): 1271-1274. DOI: 10.12354/j.issn.1000-8179.2023.20231033
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局部进展期直肠癌新辅助短程放化疗联合免疫治疗后区域淋巴结的转归

Regional lymph node regression following neoadjuvant short-course chemoradiotherapy combined with immunotherapy in locally advanced rectal cancer

    摘要
  • 摘要:
      目的  探讨局部进展期直肠癌（locally advanced rectal cancer，LARC）新辅助短程放化疗联合免疫治疗后区域淋巴结的转归。
      方法  回顾性分析2021年1月至2022年12月厦门大学附属中山医院（32例）和华中科技大学同济医学院附属协和医院（8例）收治的40例LARC患者的临床资料，以接受新辅助短程放化疗联合卡瑞利珠单抗治疗后行腹腔镜手术的20例患者为试验组，以直接行腹腔镜手术治疗的20例患者为对照组。比较两组患者术后淋巴结检出情况，以及比较试验组原发肿瘤和区域淋巴结的病理完全缓解率等。
      结果  与对照组相比，试验组N降期患者例数显著增多（18例 vs. 7例，P<0.001），淋巴结转移阳性率显著降低（1.4% vs. 9.1%，P<0.001），阳性淋巴结患者例数显著减少（4例 vs. 16例，P<0.001）。试验组淋巴结检出数略低于对照组［（18.3±8.7）枚 vs. （20.4±6.5）枚，P=0.392］。此外，试验组中区域淋巴结的病理缓解率显著高于原发肿瘤（80% vs. 30%，P=0.001）。
      结论  LARC患者经新辅助短程放化疗联合免疫治疗后阳性淋巴结的病理缓解效果显著，并推测直肠肿瘤区域淋巴结的病理缓解具有“空间效应”。

     

    Abstract:
      Objective  To investigate the regression of regional lymph nodes after administering neoadjuvant short-course chemoradiotherapy combined with immunotherapy in patients with locally advanced rectal cancer (LARC).
      Methods  This retrospective study analyzed the clinical data of 40 patients with LARC admitted to Zhongshan Hospital Affiliated to Xiamen University (32 cases) and the Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (8 cases) between January 2021 and December 2022. The control and experimental groups consisted of 20 patients who underwent direct laparoscopic surgery and neoadjuvant short-course chemoradiotherapy combined with immunotherapy prior to the laparoscopic surgery, respectively. The detection of the postoperative lymph node was compared between the two groups. In addition, the pathologic complete response (pCR) rate of the primary tumor and regional lymph nodes in the experimental group was assessed.
      Results  The number of patients with N downstaging (18 vs. 7, P<0.001) significantly increased, whereas the positive lymph node metastasis rate (1.4% vs. 19.1%, P<0.001) and number of patients with positive lymph nodes (4 vs. 16, P<0.001) significantly decreased in the experimental group compared to those in the control group. Although the number of detected lymph nodes in the experimental group was slightly lower compared to that in the control group (18.3±8.7 vs. 20.4±6.5, P=0.392), it was not statistically different. Furthermore, the pCR rate of the regional lymph nodes was significantly higher than that of the primary tumor in the experimental group (80% vs. 30%, P=0.001).
      Conclusions  Neoadjuvant short-course chemoradiotherapy combined with immunotherapy caused significant pathological remission of positive lymph nodes in patients with LARC. This study hypothesizes that a “spatial effect” contributes to the pathological remission of regional lymph nodes in rectal tumors.

     

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