Risk factors of lateral pelvic lymph node metastasis in advanced rectal cancer.
BACKGROUND
To clarify the risk factors of lateral pelvic lymph node (LPLN) metastasis of rectal cancer, we examined associations between LPLN status and clinicopathological factors including LPLN status diagnosed by computed tomography (CT).


METHODS
We reviewed a total of 210 patients with advanced rectal cancer, of which the lower margin was located at or below the peritoneal reflection, who underwent preoperative CT with 5-mm-thick sections and lateral pelvic lymph node dissection at the National Cancer Center Hospital between February 1998 and March 2006.


RESULTS
Forty-seven patients (22.4%) had LPLN metastasis. Multivariate analysis showed that LPLN status diagnosed by CT, pathological regional lymph node status, tumor location, and tumor differentiation were significant risk factors for LPLN metastasis. Among 45 patients with well-differentiated adenocarcinoma who were LPLN-negative and in whom CT had found no regional lymph node metastasis, none had LPLN metastasis. On the other hand, among 13 patients with moderate or less differentiated lower rectal adenocarcinoma who were LPLN-positive and in whom CT had revealed regional lymph node metastasis, 12 (92.3%) had LPLN metastasis.


CONCLUSIONS
LPLN status diagnosed by CT, pathological regional LN status, tumor location, and tumor differentiation are significant risk factors for LPLN metastasis. Using these factors, patients can be classified as having a low or high risk of LPLN metastasis.
Fujita
Shin
S
Department of Surgery, National Cancer Center Hospital, 1-1 Tukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan. sfujita@ncc.go.jp
Yamamoto
Seiichiro
S
Akasu
Takayuki
T
Moriya
Yoshihiro
Y
D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis / Q000473:pathology; D010386:Pelvic Neoplasms / Q000556:secondary*; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology*; D012307:Risk Factors; D015996:Survival Rate; D014054:Tomography