AJCC与JSCCR对直肠癌盆腔侧方淋巴结定义演变的解读
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摘要
侧方淋巴结清扫仍是直肠癌手术治疗的重要术式,但对于直肠癌的盆腔侧方淋巴结是否为区域淋巴结及侧方淋巴结清扫术的意义,欧美与日本专家有不同的观点。对盆腔侧方淋巴结的不同定义会导致直肠癌的分期不同,进而导致不同的治疗决策。不同时期的欧美学者及日本学者对盆腔侧方淋巴结的定义有一个演变过程,笔者根据现有资料对该演变做一解读。由于日本学者对侧方淋巴结研究较多,故重点阐述日本大肠癌研究会对侧方淋巴结的定义演变。
Lateral pelvic lymph node dissection is still the important operation for the treatment of rectal cancer. But the experts in Europe and America hold diff erent opinions from those in Japan on whether lateral pelvic lymph nodes should be considered as regional lymph nodes of rectal cancer and the signifi cance of lateral pelvic lymph node dissection. Diff erent defi nitions of lateral pelvic lymph nodes will lead to diff erent staging for rectal cancer and consequently result in diff erent treatment strategies. In diff erent periods of time, there are evolving defi nitions for lateral pelvic lymph nodes proposed by the scholars in Europe and America as well as in Japan. Here, the author interprets these evolving changes based on the available data, with the emphases on evolving defi nitions for pelvic lateral lymph nodes of the Japanese Society for Cancer of the Colon and Rectum, because more extensive eff orts have been made by Japanese scholars in this fi eld.
Lateral pelvic lymph node dissection is still the important operation for the treatment of rectal cancer. But the experts in Europe and America hold diff erent opinions from those in Japan on whether lateral pelvic lymph nodes should be considered as regional lymph nodes of rectal cancer and the signifi cance of lateral pelvic lymph node dissection. Diff erent defi nitions of lateral pelvic lymph nodes will lead to diff erent staging for rectal cancer and consequently result in diff erent treatment strategies. In diff erent periods of time, there are evolving defi nitions for lateral pelvic lymph nodes proposed by the scholars in Europe and America as well as in Japan. Here, the author interprets these evolving changes based on the available data, with the emphases on evolving defi nitions for pelvic lateral lymph nodes of the Japanese Society for Cancer of the Colon and Rectum, because more extensive eff orts have been made by Japanese scholars in this fi eld.
引文
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[2]Kim TH,Jeong SY,Choi DH,et al.Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection[J].Ann Surg Oncol,2008,15(3):729-737.doi:10.1245/s10434-007-9696-x.
[3]Kim MJ,Kim TH,Kim DY,et al.Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer?[J].J Surg Oncol,2015,111(4):459-464.doi:10.1002/jso.23852.
[4]陈峻青.大肠癌临床、病理处理规约(日本大肠癌研究会1980年)[J].浙江肿瘤通讯,1983,(1):94-124.Chen JQ.Guidelines for clinical and pathological treatment of colorectal cancer(Japanese Society for Cancer of the Colon and Rectum 1980)[J].Zhejiang cancer news,1983,(1):94-124.
[5]日本大肠癌研究会.日本大肠癌临床病理处理规范(第7版修订版)[M].北京:北京大学医学出版社,2013:6-10.Japanese Society for Cancer of the Colon and Rectum.General Rules for Clinical and Pathological Studies on Cancer of the Colon,Rectum and Anus(7threvised edition)[M].Beijing:Peking University medical press,2013:6-10.
[6]Takahashi T,Ueno M,Azekura K,et al.Lateral node dissection and total mesorectal excision for rectal cancer[J].Dis Colon Rectum,2000,43(10 Suppl):S59-68.
[7]日本大肠癌研究会.2019版《大肠癌治疗指南》.www.jsccr.jp/guideline/data/guideline_2019_cq_list.pdf.Japanese Society for Cancer of the Colon and Rectum.Guidelines for treatment of colorectal cancer 2019.www.jsccr.jp/guideline/data/guideline_2019_cq_list.pdf.
[8]Kanemitsu Y,Komori K,Shida D,et al.Potential impact of lateral lymph node dissection(LLND)for low rectal cancer on prognoses and local control:A comparison of 2 high-volume centers in Japan that employ different policies concerning LLND[J].Surgery,2017,162(2):303-314.doi:10.1016/j.surg.2017.02.005.
[9]T Watanabe SI.Management of lateral pelvic lymph nodes[J].Rectal Cancer,2018:213-230.
[10]日本大肠癌研究会.大腸癌取扱い規約第9版改訂のポイント.http://www.jsccr.jp/whatsnew/kiyaku9.html.Japanese Society for Cancer of the Colon and Rectum.Essentials of revision in the 9th edition of Classifi cation of colorectal cancer.http://www.jsccr.jp/whatsnew/kiyaku9.html.
[2]Kim TH,Jeong SY,Choi DH,et al.Lateral lymph node metastasis is a major cause of locoregional recurrence in rectal cancer treated with preoperative chemoradiotherapy and curative resection[J].Ann Surg Oncol,2008,15(3):729-737.doi:10.1245/s10434-007-9696-x.
[3]Kim MJ,Kim TH,Kim DY,et al.Can chemoradiation allow for omission of lateral pelvic node dissection for locally advanced rectal cancer?[J].J Surg Oncol,2015,111(4):459-464.doi:10.1002/jso.23852.
[4]陈峻青.大肠癌临床、病理处理规约(日本大肠癌研究会1980年)[J].浙江肿瘤通讯,1983,(1):94-124.Chen JQ.Guidelines for clinical and pathological treatment of colorectal cancer(Japanese Society for Cancer of the Colon and Rectum 1980)[J].Zhejiang cancer news,1983,(1):94-124.
[5]日本大肠癌研究会.日本大肠癌临床病理处理规范(第7版修订版)[M].北京:北京大学医学出版社,2013:6-10.Japanese Society for Cancer of the Colon and Rectum.General Rules for Clinical and Pathological Studies on Cancer of the Colon,Rectum and Anus(7threvised edition)[M].Beijing:Peking University medical press,2013:6-10.
[6]Takahashi T,Ueno M,Azekura K,et al.Lateral node dissection and total mesorectal excision for rectal cancer[J].Dis Colon Rectum,2000,43(10 Suppl):S59-68.
[7]日本大肠癌研究会.2019版《大肠癌治疗指南》.www.jsccr.jp/guideline/data/guideline_2019_cq_list.pdf.Japanese Society for Cancer of the Colon and Rectum.Guidelines for treatment of colorectal cancer 2019.www.jsccr.jp/guideline/data/guideline_2019_cq_list.pdf.
[8]Kanemitsu Y,Komori K,Shida D,et al.Potential impact of lateral lymph node dissection(LLND)for low rectal cancer on prognoses and local control:A comparison of 2 high-volume centers in Japan that employ different policies concerning LLND[J].Surgery,2017,162(2):303-314.doi:10.1016/j.surg.2017.02.005.
[9]T Watanabe SI.Management of lateral pelvic lymph nodes[J].Rectal Cancer,2018:213-230.
[10]日本大肠癌研究会.大腸癌取扱い規約第9版改訂のポイント.http://www.jsccr.jp/whatsnew/kiyaku9.html.Japanese Society for Cancer of the Colon and Rectum.Essentials of revision in the 9th edition of Classifi cation of colorectal cancer.http://www.jsccr.jp/whatsnew/kiyaku9.html.