淋巴结转移度与Ⅲ期直肠癌患者预后的关系

Prognostic value of lymph node ratio in survival of patients with stage Ⅲ rectal cancer

目的探讨淋巴结转移度（LNR）与Ⅲ期直肠癌患者预后的关系。方法回顾性分析行直肠癌根治术后的Ⅲ期直肠癌患者161例，采用Logrank检验比较各危险因素对患者预后的影响，采用Kaplan—Meier方法绘制生存曲线，采用单因素和多因素Cox回归分析影响患者预后的危险因素。结果单因素分析和多因素分析结果均提示，LNR是Ⅲ期直肠癌患者的无病生存率和总生存率的重要影响因素（均P〈0．05），而清扫的淋巴结总数和淋巴结转移数不是其影响因素（均P〉0．05）。LNR〈0．43组和LNR90．43组直肠癌患者的总生存率分别为75．8％和41．3％，差异有统计学意义（P〈0．01）；LNR〈0．43组和LNR≥0．43组直肠癌患者的无病生存率分别为68．8％和40．3％，差异有统计学意义（P=0．001）。结论相对于清扫的淋巴结总数和淋巴结转移数，LNR可作为Ⅲ期直肠癌患者的总生存率和无病生存率更有效的预测指标。

Objective To assess the prognostic value of lymph node ratio （LNR） in patients with stage Ⅲ rectal cancer after curative resection. Methods A retrospective review of the clinicopathological data was performed in 161 patients with stage Ⅲ rectal cancer who received curative surgical excision in our hospital from June 2005 to June 2010. The variables including LNR, age, gender, T stage, N stage, total number of dissected lymph nodes, number of metastatic lymph nodes, and positive rate of lymph node metastasis were studied through univariate and multivariate analyses, and the survival analysis was performed using Kaplan-Meier method and Log rank test. Results Multivariate analysis revealed that LNR, but not number of positive nodes or number of harvested lymph nodes, had independent prognostic value for overall survival and disease-free survival for patients with stage Ⅲ rectal cancer. The overall survival in the LNR 〈 0.43 and LNR ≥ 0.43 groups was 75.8% and 41.3% , respectively （P 〈 0. 01 ） , while the disease-free survival was 68.8% and 40.3% , respectively （ P = 0. 001 ）. Conclusioas The LNR is an independent prognostic factor for survival of patients with stage Ⅲ rectal cancer, and is more efficient than the number of positive nodes and total number of dissected lymph nodes in the survival prediction.