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| 病理科医师细致取材对新辅助放化疗直肠癌患者术后淋巴结检测结果的影响 |
| 赵权权1,于志奇2,郑建明3,傅传刚1,于恩达1,张卫1,孟荣贵1,王汉涛1,郝立强1,王颢1* |
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(1. 第二军医大学长海医院肛肠外科, 上海 200433;
2. 解放军306 医院胸外科, 北京 100101;
3. 第二军医大学长海医院病理科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 探讨多学科合作后病理科医师细致取材对新辅助放化疗直肠癌患者术后淋巴结检测结果的影响。方法 回顾性分析第二军医大学长海医院肛肠外科2005年1月至2014年12月收治的接受新辅助放化疗及根治性手术的191例Ⅰ~Ⅲ期直肠癌患者的临床资料。自2009年1月起与病理科开展直肠癌多学科合作，病理科医师通过细致取材使每例直肠癌患者术后淋巴结检出数量不少于15枚，据此将患者分为常规取材组（46例）和细致取材组（145例）。比较两组患者术后淋巴结的检出数量及阳性率。结果 细致取材组患者术后淋巴结的检出数量较常规取材组增加[（13.1±4.9）枚/例vs （9.6±4.0）枚/例，P<0.01]，其中≥12枚的比例提高（69.7% vs 33.3%，P<0.01）。常规取材组患者术后阳性淋巴结数量[（1.8±2.9）枚/例vs（1.9±3.8）枚/例，P=0.334]和淋巴结阳性率（50.0% vs 38.6%，P=0.172）与细致取材组相比差异均无统计学意义。T0、T1、T2、T3和T4期常规取材组和细致取材组患者的淋巴结阳性率分别为25.0%（1/4）和22.7%（5/22）、0.0%（0/1）和33.3%（1/3）、9.1%（1/11）和25.0%（8/32）、70.0%（21/30）和47.1%（40/85）及0.0%（0/0）和66.7%（2/3），不同T分期之间两组患者的淋巴结阳性率差异无统计学意义（χ2=4.55，P=0.209）。结论 多学科合作后病理科医师细致取材可增加接受新辅助放化疗患者术后淋巴结的检出数量，但并不增加阳性淋巴结的检出数量及淋巴结阳性率。对于接受新辅助放化疗的直肠癌患者建议选择淋巴结辅助检出技术以获得更准确的淋巴结情况。 |
| 关键词: 大肠癌 病理科医师 新辅助放化疗 淋巴结 |
| DOI：10.16781/j.0258-879x.2017.12.1567 |
| 投稿时间：2017-07-04修订日期：2017-10-13 |
| 基金项目:国家自然科学基金（81172307）. |
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| Effects of meticulousness of pathologists on lymph node harvest after neoadjuvant chemoradiotherapy combined radical resection of patients with rectal cancer |
| ZHAO Quan-quan1,YU Zhi-qi2,ZHENG Jian-ming3,FU Chuan-gang1,YU En-da1,ZHANG Wei1,MENG Rong-gui1,WANG Han-tao1,HAO Li-qiang1,WANG Hao1* |
(1. Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
2. Department of Thoracic Surgery, No. 306 Hospital of PLA, Beijing 100101, China;
3. Department of Pathology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the effect of meticulousness of pathologists on the lymph node harvest after radical resection of invasive rectal carcinoma in paients following neoadjuvant chemoradiotherapy. Methods The clinical data of 191 patients with rectal cancer (stage Ⅰ to Ⅲ) undergoing radical excision after neoadjuvant chemoradiotherapy in Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University from Jan. 2005 to Dec. 2014 were retrospectively analyzed. Since Jan. 2009 when multidisciplinary cooperation was carried out, pathologists and surgeons suggested that no less than 15 lymph nodes in single rectal specimen should be found by meticulousness of pathologists, according to which patients were divided into routine sampling group (n=46) and meticulousness group (n=145). The harvest number and positive rate of postoperative lymph nodes were compared between the two groups. Results The lymph node retrieval in the meticulousness group was significantly more than that in the routine sampling group (13.1±4.9 vs 9.6±4.0, P<0.01), and the percentage of patients with the lymph node harvest equaling or more than 12 was significantly increased (69.7% vs 33.3%, P<0.01). There were no significant differences in the positive node harvest number (1.8±2.9 vs 1.9±3.8, P=0.334) or positive rate of lymph nodes (50.0% vs 38.6%, P=0.172) between the two groups. The positive rate of lymph nodes of patients in T0, T1, T2, T3, and T4 stages in the two groups were 25.0%(1/4) and 22.7%(5/22), 0.0%(0/1) and 33.3% (1/3), 9.1%(1/11) and 25.0%(8/32), 70.0%(21/30) and 47.1%(40/85), and 0.0%(0/0) and 66.7%(2/3), respectively. There were no significant differences in T stages between the two groups (χ2=4.55, P=0.209). Conclusion The lymph node harvest number is increased by meticulousness of pathologists after multidisciplinary cooperation, while the positive node harvest number and positive rate of lymph nodes are not increased, suggesting that supplementary measures should be taken to obtain more accurate lymph node status of patients with rectal cancer after neoadjuvant chemoradiotherapy. |
| Key words: colorectal carcinoma pathologist neoadjuvant chemoradiation lymph node |
