医学
解剖(医学)
淋巴结
结直肠癌
放射科
新辅助治疗
转移
淋巴
放化疗
癌症
外科
放射治疗
内科学
病理
乳腺癌
作者
Taehee Lee,Natally Horvat,Marc J. Gollub,Julio García‐Aguilar,Tae‐Hyung Kim
标识
DOI:10.1016/j.ejrad.2024.111601
摘要
Purpose To systematically review and meta-analyze the prognostic significance of lateral lymph node metastasis (LLNM) on pretreatment MRI in patients with rectal cancer who undergo neoadjuvant chemoradiation followed by curative surgical resection without lateral lymph node dissection (LLND). Methods We searched the MEDLINE and EMBASE databases until September 27, 2023, utilizing the following search terms: (rectal OR rectum OR colorectal) AND (lateral OR sidewall) AND (lymph OR node). The QUIPS tool was employed to evaluate methodological quality. We pooled the association between LLNM on pretreatment MRI and outcomes such as local recurrence, distant metastasis, disease-free survival, and overall survival using hazard ratio (HR) and odds ratio (OR) based on random effects model. Results We included 9 studies, encompassing 3180 patients. LLNM on pretreatment MRI revealed a significant association with increased local recurrence rates (HR: 4.11; 95% CI: [1.87, 9.02]) and elevated risks for both disease-free (HR: 1.70; 95% CI: [1.42, 2.03]) and overall survival (HR: 1.76; 95% CI: [1.44, 2.15]). As for distant metastasis, our analysis indicated a potential trend towards increased rates, though this did not reach statistical significance (HR: 1.67; 95% CI: [0.85, 3.27]). Conclusions Our findings underscore the relationship between LLNM and increased local recurrence and compromised disease-free and overall survival. This emphasizes the potential limitations of relying solely on neoadjuvant chemoradiation and highlights the potential need to intensify treatment in select patients.
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