淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响

Influence of the Number of Lymph Nodes Retrieved on the Prognosis of Colorectal Cancer Dukes' Stage B and C

目的:探讨淋巴结检出数对Dukes'B期及C期大肠癌患者预后的影响。方法:回顾分析373例Dukes'B期及C期患者的临床病理特征与淋巴结检出数的关系,及不同淋巴结检出数对患者预后的影响。结果:全组患者淋巴结检出数为13.71±9.38枚,肿瘤部位、大小及肿瘤浸润深度是影响淋巴结检出数的主要因素,结肠癌患者淋巴结检出数为17.51±12.79枚,显著多于直肠癌患者的11.09±6.17枚(P=0.000)。淋巴结检出较少(0～10枚)的Dukes'B期大肠癌患者,其5年生存率仅为60.4%,而淋巴结检出较多(>10枚)的Dukes'B期患者,其5年生存率为74.5%,两者比较具有显著性差异(P=0.002)。但淋巴结检出数对Dukes'C期大肠癌患者的预后无影响(P>0.05)。将结、直肠癌患者分别分析表明,直肠癌患者淋巴结检出数<9枚,结肠癌患者淋巴结检出数<13枚时,其5年生存率显著降低(P<0.05)。结论:为保证分期的准确及指导适宜的术后辅助治疗,直肠癌患者术后至少应检出9枚淋巴结,结肠癌患者至少应检出13枚淋巴结。

Objectives： To discuss the influence of the number of lymph nodes retrieved on the prognosis of colorectal cancer of Dukes＇ stage B and C. Methods： Clinicopathologic features of 373 patients with colorectal cancer of Dukes＇ stage B and C were retrospectively reviewed. The relationship between the number of lymph nodes retrieved and prognosis of these patients was analyzed. Results： The mean number of recovered lymph nodes in all colorectal cancer patients was 13.71±9.38. Tumor site, tumor size and depth of invasion influenced the number of lymph nodes retrieved. The average number of retrieved lymph nodes in colon cancer patients was 17.51±12.79; whereas in rectal cancer patients it was 11.09±6.17 （P=0.000）. The 5-year survival rate for patients with fewer lymph nodes （0- 10） retrieved was 60.4%, lower than the 77.5% for patients with more lymph nodes retrieved （≥ 10）. The number of lymph nodes retrieved did not affect the prognosis for Dukes＇ stage C patients. If the number of retrieved lymph nodes was lower than 9 in rectal cancer patients or lower than 13 in colon cancer patients, the 5-year survival rate was dramatically decreased. Conclusion： A minimum number of 9 lymph nodes in rectal cancer patients and 13 lymph nodes in colon cancer patients should be removed to obtain the best prognosis.