淋巴结转移度与结直肠癌预后关系研究

Study of relation between lymph nodes metastatic ratio and prognosis of colorectal cancer

目的 探讨淋巴结转移度（LNR）与结直肠癌术后5年无病存活率和总存活率的关系。 方法 对2000年1月至2004年4月北京大学人民医院胃肠外科行根治性手术治疗的124例结直肠癌进行分析。将124例Ⅲ期结直肠癌依据LNR分为3组： LNR＜0.167、LNR≥0.167~＜0.562、LNR≥0.562，比较组间预后差异。分析诸临床病理因素与结直肠癌预后之间的关系。 结果 LNR和转移淋巴结数目均与结直肠癌术后5年无病存活率和总存活率相关，而LNR是总存活率的独立相关因素。对淋巴结病理检查数目未超过12枚的病例，LNR与5年无病存活率相关。 结论 LNR与Ⅲ期结直肠癌的预后相关；对伴淋巴结转移的结直肠癌，特别是淋巴结病理检查数目相对较少的病例，应考虑将LNR作为临床病理分期的补充。

Objective To study the relation between lymph nodes metastatic ratio（LNR）and disease-free survival （DFS） as well as overall survival （OS） in stage III colorectal cancer. Methods One hundred and twenty-four patients with stage III colorectal cancer performed radical resection between January 2000 and April 2004 in the Department of Gastrointestinal Surgery, Peking University People’s Hospital were analyzed. Patients were assigned to 3 groups based on LNR： LNR〈0.167, 0.167≤LNR〈0.562 and LNR≥0.562. The relation between overall and disease-free survival at 5 years and 10 variables including age, sex, tumor location, size, grade, histology, T stage, number of positive LNs, and LNR, was analyzed by multivariate analysis. Survival curves were constructed using the Kaplan-Meier method. Results Both LNR and the number of positive LNs were significant prognostic factors for 5ys-DFS and OS in patients with stage III colorectal cancer. LNR was an independent prognostic factor for 5ys-OS. LNR remained an independent prognostic factor in patients with not more than 12 lymph nodes examined. Conclusion LNR is an important prognostic factor in patients with stage III colorectal cancer, which should be used in future staging systems or stratification schemes for colorectal caner with metastatic LNs, especially for not more than 12 lymph nodes examined.