淋巴结检出数和淋巴结转移度对Ⅱ～Ⅲ期结直肠癌患者预后的影响

Impact of number of retrieved lymph nodes and lymph node ratio on the prognosis in patients with stage Ⅱ and Ⅲ colorectal cancer

目的 探讨淋巴结检出数和淋巴结转移度（LNR）对Ⅱ～Ⅲ期结直肠癌患者预后的影响.方法 回顾性分析507例Ⅱ～Ⅲ期结直肠癌患者的临床病理资料和随访资料.结果 507例患者共计检出淋巴结5801枚;转移淋巴结1122枚;淋巴结转移数与检出数呈正相关（r=0.171,P＜0.01）.淋巴结检出数大于或等于12枚与小于12枚的Ⅱ期患者,5年生存率分别为80.5%和62.7%,差异有统计学意义（P＜0.01）;而Ⅲ期患者则差异无统计学意义（P＞0.05）.不同LNR的Ⅱ～Ⅲ期结直肠癌患者5年生存率差异有统计学意义（P＜0.01）.不同淋巴结转移区域的同一LNR组患者的5年生存率差异也有统计学意义（P＜0.05,P＜0.01）.结论 淋巴结检出数对Ⅱ期结直肠癌患者预后的影响更为明显.为了获得更准确的分期及更好的预后,术中应尽量检出12枚/例以上淋巴结.LNR是Ⅱ～Ⅲ期结直肠癌的预后因素,用其评估患者预后时应兼顾淋巴结转移区域.

Objective To discuss the impact of number of retrieved lymph nodes and lymph node ratio （LNR） on the prognosis in patients with stage Ⅱ and Ⅲ colorectal cancer.Methods Clinicopathological data of 507 patients with stage Ⅱ and Ⅲ colorectal cancer were analyzed retrospectively. Follow-up was available in all the patients. Results The total number of retrieved lymph nodes was 5801, of which 1122 had metastasis. There was a positive correlation between metastatic lymph nodes and retrieved lymph nodes （r=0. 171, P＜0.01）. In stage Ⅱ colorectal cancer there was a significant difference in 5-year survival rate between patients with more than 12 lymph nodes retrieved and those with less than 12 lymph nodes retrieved （P＜0.01）. LNR also affected the 5-year survival rate of patients with stage Ⅱ and Ⅲ colorectal cancer （P＜0.05）. In patients with similar LNR, the 5-year survival rate differed significantly among different regions of lymph node metastasis（P＜0.05）. LNR influenced the prognosis independent of the number of lymph nodes retrieved. Conclusions The number of retrieved lymph nodes is a prognostic factor for stage Ⅱ and Ⅲ colorectal cancer. More than 12 lymph nodes should be retrieved for better staging and prognosis. LNR is also a prognostic factor in stage Ⅱ and Ⅲ colorectal cancer. Regions of lymph nodes metastasis should be considered when evaluating the prognosis of patients using LNR.