| Research background and purpose:Positive lymph nodes and tumor deposits were found in rectal cancer surgical specimens with or without neoadjuvant therapy.Patients with low and middle rectal cancer who still had positive lymph nodes after neoadjuvant therapy had the same pathological outcome as those who did not have positive lymph nodes after neoadjuvant therapy,and their impact on survival remains unclear.In this paper,by comparing the difference in survival of patients with postoperative pathological lymph node positive and/or tumor deposition(tumor less than 10 cm from the anus)with patients who received neoadjuvant therapy and those who did not receive neoadjuvant therapy,the influence of postoperative positive lymph nodes and cancer nodules on tumor recurrence and distant metastasis was discussed,providing certain reference for clinical practice and cognition.Materials and Methods:Clinical and pathological data of patients with medium-low rectal cancer who completed neoadjuvant therapy and radical postoperative surgery with positive lymph node metastasis(yp N+)and patients without neoadjuvant therapy with positive lymph node(p N+)were retrospectively collected from Sichuan Cancer Hospital from January2015 to December 2018.The detailed information of tumor recurrence,distant metastasis or death in these two types of patients was obtained through follow-up,and the differences in recurrence,metastasis and survival were compared between patients who received neoadjuvant therapy and those who did not receive neoadjuvant therapy in patients with middle and low rectal cancer with positive pathological samples of lymph nodes after surgery.Meanwhile,the differences in Disease-free Survival(DFS)and Overall Survival(OS)were compared between the groups of Tumor Node(TD)positive yp N+ and yp N-patients and TD negative p N+ and p N-patients.Result:1.A total of 154+1050 patients were included in this study,including 48 patients with yp N+,278 patients with p N+,and 2 patients lost to follow-up after surgery.After 1:1case matching through propensity score matching,40 patients in each case were included in this study.The median follow-up time was 52 months.2.Recurrence and/or metastasis occurred in 24 patients(60.0%)in yp N+ group and 21patients(52.5%)in PN+ group;The mortality rate was 47.5% in yp N+ group and 40%in p N+ group.The 5-year DFS of yp N+ group and p N+ group were 39.5% and 37.2%,respectively,with no statistical difference(P=0.54).The 5-year OS of yp N+ group and p N+ group was 49.5% and 53.6%,respectively,showing no statistical difference(P=0.69).The 5-year DFS of TD positive yp N+ patients and p N+ patients were 25.0%and 29.6%,respectively,with no statistical difference(P=0.54).The 5-year OS of TD positive yp N+ patients and p N+ patients was 37.5% and 40.0%,respectively,with no statistical difference(P=0.78).The 4-year DFS of TD negative yp N+ patients and p N+patients were 50.0% and 56.0%,respectively,with no statistical difference(P=0.65).The 4-year OS of TD negative yp N+ patients and p N+ patients was 75.0% and 72.0%,respectively,with no statistical difference(P=0.78).3.The clinicopathologic data of yp N+ group after PSM were as follows: There were 40patients(86.9%)in yp N+ group,with an average age of 57.2±10.1 years.Preoperative imaging T-stage: 1 case(2.5%)of c T2,20 cases(50.0%)of c T3,19 cases(47.5%)of c T4.The mean number of positive lymph nodes was 3(1-16).N stages were observed in 17 cases(42.5%)of yp N1 a,14 cases(35.0%)of yp N1 b,and 9 cases(22.5%)of yp N2.Among them,16 patients(40.0%)were TD positive.Among them,24 patients(60.0%)were TD negative.Clinical and pathological data of p N+ group after PSM: 40 patients(14.4%)in p N+ group,average age 69.2±10.8 years old,postoperative imaging T stage:7 cases(17.5%)of p T2,17 cases(42.5%)of p T3,16 cases(40.0%)of p T4.The mean number of positive lymph nodes was 4(1-22).Postoperative N stage: p N1a(15 cases)(37.5%),p N1b(11 cases)(27.5%),p N2(14 cases)(35.0%);There were 15(37.5%)TD-positive patients and 25(62.5%)TD-negative patients.Conclusion:1.There was no significant difference in 5-year OS and 5-year DFS between patients who received neoadjuvant therapy and those who did not receive neoadjuvant therapy.Preoperative neoadjuvant therapy or postoperative supplemental adjuvant therapy had no effect on survival prognosis.2.There was no significant difference in 5-year OS and 5-year DFS between yp N+patients with positive cancer nodules and p N+ patients with positive cancer nodules.3.There was no significant difference in 5-year OS and 5-year DFS between yp N+patients with negative cancer nodules and p N+ patients with negative cancer nodules.4.Positive cancer nodules after surgery may be an important risk factor for survival and prognosis of patients with positive lymph nodes after surgery. |
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