新辅助治疗后局部晚期直肠癌患者取回的淋巴结数量:STELLAR 试验的事后分析。

IF 3.5 3区 医学 Q1 SURGERY BJS Open Pub Date : 2024-09-03 DOI:10.1093/bjsopen/zrae118
Yueyang Zhang, Yuan Tang, Huiying Ma, Hao Su, Zheng Xu, Changyuan Gao, Haitao Zhou, Jing Jin
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引用次数: 0

摘要

背景:目前治疗腹膜外局部晚期直肠癌的金标准是新辅助治疗(TNT)后进行全直肠系膜切除术。本研究探讨了TNT治疗后局部晚期直肠癌患者的淋巴结数量及其与生存期的相关性:这是一项基于STELLAR试验的事后分析,包括来自16个三级中心的局部晚期直肠癌患者,他们在2015年至2018年间被随机分配为短期放疗后化疗组(TNT组)或长期同期化疗组后全直肠系膜切除术。本淋巴结相关分析基于 TNT 组。亚组根据淋巴结切除情况进行区分(低于中位数:有限淋巴结切除组,大于/等于中位数:扩大淋巴结切除组)。主要结果为总生存期和无病生存期(DFS)。研究还探讨了与临床/病理变量、淋巴腺切除类别和辅助化疗使用的相关性:在参加STELLAR试验的451名患者中,有227名患者(50.3%)被分配到TNT组,其中女性占29.5%。TNT组淋巴结取材的中位数为11.0个。有限淋巴结切除术亚组患者的总生存率低于扩大淋巴结切除术亚组患者(HR 2.95 (95% c.i. 1.47 to 5.92),P = 0.001)。ypN0局限亚组和ypN1扩展亚组的总生存率相似(HR 0.38(95% c.i.0.11至1.30),P = 0.109)。与不进行辅助化疗相比,辅助化疗可提高总生存率和DFS(P<0.001),在淋巴结切除术受限的亚组中也是如此(P<0.001)。然而,在扩大淋巴腺切除术亚组中,采用或不采用辅助化疗在总生存期或DFS方面没有明显差异(分别为P = 0.887和P = 0.192):结论:在STELLAR试验中,切除淋巴结的中位数为11个。结论:在STELLAR试验中,淋巴结切除的中位数为11个。在淋巴腺切除术受限的患者中,TNT术后使用辅助治疗是有益的,与未接受辅助化疗的患者相比,辅助治疗与更好的预后相关。
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Number of lymph nodes retrieved in patients with locally advanced rectal cancer after total neoadjuvant therapy: post-hoc analysis from the STELLAR trial.

Background: The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival.

Materials and methods: This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored.

Results: Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively).

Conclusion: In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.

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BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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