目前腹膜外局部晚期直肠癌的金标准是完全新辅助治疗（TNT），然后进行全直肠系膜切除。本研究探讨了局部晚期直肠癌患者 TNT 后的淋巴结数量及其与生存的相关性。这是基于 STELLAR 试验的事后分析，包括来自 16 个三级中心的局部晚期直肠癌患者，这些患者被随机分组2015年至2018年间短期放疗后化疗（TNT组）或长期同步化疗后全直肠系膜切除组。本次淋巴结相关分析基于TNT组。根据淋巴结收获情况区分亚组（低于中位数：有限淋巴结切除术组，大于/等于中位数：扩大淋巴结切除术组）。主要结局是总生存期和无病生存期（DFS）。探讨了与临床/病理变量、淋巴结清扫类别和辅助化疗使用的相关性。在参加 STELLAR 试验的 451 名患者中，227 名患者（50.3%）被分配到 TNT 组，其中 29.5% 为女性。 TNT 组中取出的淋巴结中位数为 11.0 个。有限淋巴结切除亚组的患者总体生存率比扩大淋巴结切除组的患者差（HR 2.95（95% c.i. 1.47 至 5.92），P = 0.001）。 ypN0 限制亚组和 ypN1 扩展亚组的总生存率相似（HR 0.38（95% c.i. 0.11 至 1.30），P = 0.109）。与无辅助化疗（P < 0.001）和有限淋巴结切除亚组（P < 0.001）相比，辅助化疗与更好的总生存期和 DFS 相关。然而，在扩大淋巴结切除术亚组中，有或没有辅助化疗的总生存率或 DFS 没有显着差异（分别为 P = 0.887 和 P = 0.192）。在 STELLAR 试验中，收获的淋巴结中位数为 11 个。对于淋巴结清扫有限的患者，与未接受辅助化疗的患者相比，TNT 后使用辅助治疗是有益的，并且与更好的预后相关。© 作者 2024。由牛津大学出版社代表 BJS Foundation Ltd 出版。

The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival.This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored.Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively).In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.