RESUMO
BACKGROUND/AIMS: We aimed to clarify the oncological significance of the number of lymph nodes in rectal cancers treated with preoperative chemoradiotherapy. METHODOLOGY: We studied 126 curatively operated patients with clinical T3-T4 and M0 rectal cancers. The number of lymph nodes and clinicopathological features were compared between the patients treated with surgery alone (OP group, n = 45) and those treated with preoperative chemoradiotherapy (50-50.4 Gy in 25-28 fractions with tegafur-uracil and leucovorin, CRT group, n = 81). Factors influencing lymph node count and its prognostic significance were analyzed. RESULTS: The CRT group had significantly fewer lymph nodes than the OP group (12.4 vs. 21.1, P < 0.0001). High histological regression of rectal lesions was significantly correlated with decreased lymph node count in the CRT group. In the OP group, the 5-year cancer-specific survival rate of the patients with 12 or more lymph nodes was significantly better than those with fewer than 12 lymph nodes (75.1% vs. 33.3%, P = 0.02); in the CRT group, on the other hand, these survival rates did not differ (84.5% vs. 77.5%, P = 0.6). CONCLUSIONS: The number of lymph nodes in rectal cancer was correlated with the response of primary rectal lesions to chemoradiotherapy, and was not associated with patient survival.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Linfonodos/patologia , Terapia Neoadjuvante , Neoplasias Retais/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/mortalidade , Progressão da Doença , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Feminino , Humanos , Estimativa de Kaplan-Meier , Leucovorina/administração & dosagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Estadiamento de Neoplasias , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tegafur/administração & dosagem , Fatores de Tempo , Resultado do TratamentoRESUMO
A 74-year-old female had occasionally experienced right lower abdominal pain in the past. She underwent a barium enema examination during a medical checkup, which revealed a wall irregularity around the appendix, but the appendix itself was not visualized. The patient was referred to our hospital for possible appendiceal neoplasm. Colonoscopy revealed a tumor-like protrusion with marked redness at the entrance to the appendix. Pathologic analysis of biopsy specimens revealed only inflammatory cells. Differential diagnosis of appendiceal Crohn's disease or appendiceal neoplasm was made, and laparoscopic appendectomy was performed. Pathologic examination revealed inflammation in all layers of the appendiceal wall and noncaseating epithelioid cell granuloma, and a diagnosis of appendiceal Crohn's disease was made. The postoperative course was uneventful, and the patient was discharged from the hospital 3 days after surgery. No sign of recurrence has been observed up to now, 6 months after surgical treatment.