Post-hoc analysis of clinicopathological factors affecting lateral lymph node metastasis based on STELLAR study for rectal cancer

作者：Li-Ning Chen, Jun Jiang, Liming Jiang, Haitao Zhou, Ning Li, Ning-Ning Lu, Yuanhong Gao, Shixin Liu, Wen‐Ling Wang, Lichun Wei, Shuai Li, Yong Cai, Yongheng Li, Shulian Wang, Yueping Liu, Yong-Wen Song, Hui Fang, Bo Chen, Ye‐Xiong Li, Jing Jin, Yuan Tang · 发表于：Radiotherapy and Oncology · 年份：2024 · DOI：10.1016/j.radonc.2024.110512 · 被引用次数：5 · 研究领域：Colorectal Cancer Surgical Treatments、Colorectal and Anal Carcinomas、Endometrial and Cervical Cancer Treatments

PURPOSE: In post-hoc analyses of phaseIII randomized controlled study(STELLAR), to analyzethe prognostic impact oflateral pelvic lymph node (LPLN)metastasis in locally advanced rectal cancer (LARC). METHODS: LPLN metastasis was defined as a short diameter > 7 mm on magnetic resonance imaging (MRI).The studyincluded 591 patients with LARC.All patients received neoadjuvant (chemo)radiotherapy combined withradical resection. RESULTS: Among 591 patients, 99 (16.8 %) were diagnosed with LPLN metastasis, mostly with unilateral metastasis (79.8 %), with internal iliac lymph node metastasis being more common (81.8 %).Significant differences were found among with and without LPLN metastasis in rectal segmentation (P=0.001),N disease (P<0.001), mesenteric LN metastasis or not (P=0.030). The median follow-up timewas 34.0 months, three-year disease-free survival (DFS),overall survival (OS), andmetastasis-free survival (MFS)were significantly lower in LPLN metastaticgroup than those in LPLN non-metastaticgroup (51.4 % vs. 68.2 %, P<0.001; 71.8 % vs. 84.2 %, P=0.006; 60.8 % vs. 80.1 %,P<0.001), respectively; while there were no significant differences in locoregional recurrence(11.4 % vs. 8.5 %, P=0.564). Multivariate analysis found that LPLN metastasis was an independent prognostic factor affecting DFS (P=0.005), OS (P=0.036),MFS (P=0.001).No significantly survival benefit was observed for the short-term radiotherapy based total neoadjuvant therapy compared to long-term concurrent chemora...