Ⅲ期结直肠癌淋巴结转移比率与预后的关系

Relationship between metastatic lymph nodes ratio and prognosis in stage Ⅲ colorectal cancer

目的探索Ⅲ期结直肠癌的淋巴结转移比率与其临床病理特征及预后的关系。方法将247例Ⅲ期结直肠癌患者根据淋巴结转移比率(MLR)的中位数分为3个组:低比率组(≤0.21),中比率组(>0.21～0.42),高比率组(>0.42)。分析比较各组的临床病理因素和5年生存率的差别,并采用Cox比例风险模型分析Ⅲ期结直肠癌预后的相关因素。结果 247例Ⅲ期结直肠癌的淋巴结转移比率为0.02～1.00,中位数为0.21,在低比率组中,高中分化的结直肠癌的所占比例(57.9%,113/195)明显高于低分化癌的比例(23.1%,12/52)(P<0.01);≥12枚病检淋巴结的结直肠癌所占比例(56.5%,95/168)明显高于<12枚淋巴结的比例(38.0%,30/79)(P<0.05)。低比率组、中比率组、高比率组的5年生存率分别为67.4%,28.8%,6.3%,3组生存率存在明显差异(P<0.05)。多因素Cox回归模型分析表明,淋巴结转移比率是Ⅲ期结直肠癌预后的重要因素。结论 MLR是判断Ⅲ期结直肠癌预后的一个重要指标。

Objective To study the relationship between metastatic lymph nodes ratio（MLR） with stage Ⅲ colorectal cancer and its clinicopathological features as well as prognosis. Methods According to the median number of MLR,247 patients with stage Ⅲ colorectal cancer were divided into three groups that were low-ratio（≤0.21）,middle-ratio（0.21-0.42） and high-ratio（0.42） group,respectively.The differences of clinicopathological factors and the 5-year overall survival rate among the groups were analyzed,and the related prognostic factors of the stage Ⅲ colorectal cancer were analyzed by using Cox proportional hazards model. Results The MLR of 247 cases ranged between 0.02-1.00 with median of 0.21.Of the low-ratio group,the proportion of the well to moderately differentiated colorectal carcinoma was 57.9%（113/195）,which was significantly higher than that of the poorly differentiated colorectal carcinoma（23.1%,12/52）（P0.01）,and the proportion of the patients who had at least 12 lymph nodes examined was 56.5%（95/168）,which was significantly higher than that of the patients who had less than 12 lymph nodes examined（38.0%,30/79）（P0.05）.The 5-year survival rate of the low-ratio,middle-ratio and high-ratio group was 67.4%,28.8% and 6.3%,respectively,and there was a significant difference in 5-year survival rate among the three groups（P0.05）.The multivariate Cox regression model revealed that the MLR was an important factor for prognosis of stage Ⅲ colorectal cancer. Conclusions MLR is an important parameter for determining the prognosis of stage Ⅲ colorectal cancer.