结直肠癌单个转移淋巴结分布情况及其预后意义研究

Distribution of Single Metastasized Lymph Nodes and Its Significance in the Prognosis of Colorectal Carcinoma

目的:通过研究结直肠癌单个转移的淋巴结分布情况及其在预后中的作用,探讨淋巴结转移规律及转移位置的预后评估价值。方法:收集分析中山大学附属肿瘤医院1993年2月～2008年6月行根治性手术且术后常规病理检测只有一个淋巴结转移结直肠腺癌患者资料。结果:共收集病例263例,单个淋巴结跳跃转移率35%。淋巴结转移分布影响因素多分类Logistic回归示送检淋巴结个数和病理分级是影响系膜组淋巴结转移因素,年龄是影响系膜动脉结扎处淋巴结转移因素。TNM分期ⅢA期5年生存率88.4%,ⅢB期73.1%,5年生存有差异。中国分期Dukes’C_1期和Dukes’C_2期5年生存无显著性差异。影响预后因素cox回归显示5年生存率与性别、病理分级、淋巴结转移率、TNM分期有关。结论:单个转移的淋巴结有很高的概率分布在远离肿瘤的位置,清扫系膜根部淋巴结是必要的。淋巴结转移率而不是淋巴结转移位置对生存率有显著影响,按淋巴结转移位置进行分期意义不大。

Objective： To explore the prognostic value of the site of nodal metastasis by studying the distribution of single metastasized lymph nodes and its role in the prognosis of colorectal carcinoma （CRC）. Methods： Data were collected from 263 CRC patients who underwent radical surgery and had only one metastasized lymph node seen in our hospital between February 1993 and January 2008. All patients were followed up. Results： In the 263 cases, skip metastasis of a single node occurred in 35%. The Multifactorial Logistic Regression Analysis for distribution of the nodal metastasis revealed that the number of lymph nodes detected and pathologic grading were factors affecting mesenteric node metastasis. Age was a factor affecting nodal metastasis at the ligation of the mesenteric artery. Based on TNM staging, the 5-year survival rate was 88.4% in stage IliA cases and 73.1% in stage IIIB cases. There was a significant difference between the two groups. However, there were no significant differences between Duke＇ s stage C 1 and Duke＇ s stage C2 according to the Chinese staging for eoloreetal cancer. COX regression analysis indicated that the 5-year survival rate was related to sex, tumor differentiation, lymph node metastatic ratio, and TNM stage. Conclusions： It is the skip rate in CRC skip metastasis to lymph nodes instead of the location of the metastasis that has a significant effect on the survival rate. There is less significance to stage CRC based on the site of the nodal metastasis than the skip rate.