Ⅲ期结直肠癌淋巴结转移率的预后作用

Metastatic lymph node ratio and outcome of surgical patients with stageⅢcolorectal cancer

目的评估淋巴结转移率(LNR)在Ⅲ期结直肠癌预后中的作用。方法随访收集Ⅲ期结直肠癌临床病理资料,采用Kaplan-Meier方法计算5年无瘤生存率(DFS)和总生存率(OS),单因素和多因素分析LNR与DFS和OS的相关性。结果中位随访时间62.5月,5年总DFS和OS分别为51.8%和56.3%。术后病理标本获取的中位淋巴结数为10个,转移淋巴结中位数为3个。根据LNR分布的四分位数分组为LNR1(LNR≤0.125),LNR2(0.125<LNR2≤0.260),LNR3(0.260<LNR3≤0.500)和LNR4(LNR4>0.500),其5年DFS分别为64.2%、53.5%、41.8%和25.7%(P<0.05);5年OS分别为68.1%、60.8%、49.2%和32.7%(P<0.05)。多因素分析显示年龄、T分期、淋巴结数目和LNR是预后的独立相关因素。根据淋巴结获取的数目分层(≤12个淋巴结,>12个淋巴结)分析,LNR的预后作用独立于获取淋巴结数。结论 LNR具有独立的预后作用并且优于TNM分期中的淋巴结分期预后作用。

Objective o evaluate the prognostic value of lymph node ratio （LNR） in patients undergoing resection of stage Ⅲ colorectal cancer. Methods The clinicopathological and follow-up data were collected from 174 surgical patients with stage Ⅲ colorectal cancer. The 5-year disease-free survival （DFS） and overall survival （OS） were evaluated using Kaplan-Meier method. The impact of LNR and clinicopathological factors on DFS and OS were evaluated using univariate and multivariate analysis. Results After a median follow-up of 62.5 months, the 5-year DFS and OS of the patients were 51.8% and 56.3%, respectively. The median number of lymph nodes harvested and the median number of positive lymph nodes examined were 10 and 3, respectively. The patients were stratified into 4 groups according to LNR quartiles （LNR1, LNR≤0.125; LNR2, 0.125〈LNR5 0.260; LNR3, 0.260〈LNR≤0.500; LNR4, LNR〉0.500）, whose 5-year DFS and OS were 64.2%, 53.5%, 41.8%, and 25.7% （P〈0.05） and 68.1%, 60.8%, 49.2%, and 32.7% （P〈0.05）, respectively. Multivariate analysis identified age, T stage and LNR as the independent predictors of both DFS and OS. Subgroup analysis showed that LNR had an independent prognostic value on DFS and OS irrespective of the number of lymph nodes harvested. Conclusion LNR is an independent prognostic factor for survival in patients with stage Ⅲ colorectal cancer and is superior to the pN category in TNM staging.