Ⅱ期结肠癌根治术淋巴结检取影响因素及预后价值分析

Affecting factors of lymph nodes retrieved number and prognostic value in stage Ⅱ colon cancer after radical surgery

目的:探讨Ⅱ期结肠癌根治术淋巴结检取的影响因素及预后价值。方法:收集2000-01-05-2009-12-31中国医科大学附属第四医院胃肠外科手术治疗且未经辅助治疗的Ⅱ期结肠癌患者216例,回顾性分析淋巴结检出数量与临床病理学特征的关系,采用单因素、多因素Cox比例风险模型和Kaplan-Meier法进行生存分析。结果:2000-01-2009-12淋巴结检出≥12个的比例从8.0%提高到91.7%。结肠癌淋巴结检出≥12个的患者2005-2009年手术者多于2000-2004年手术者,右半结肠癌多于左半结肠癌,肿瘤直径≥5cm多于<5cm者,T4a^T4b期多于T3期。淋巴结检出数量与手术年代(χ2=45.188,P<0.001)、肿瘤部位(χ2=5.413,P=0.020)、肿瘤大小(χ2=4.021,P=0.045)及T分期(χ2=8.533,P=0.014)明显相关,而与性别、年龄、病理类型、分化及术前CEA水平无明显相关。单因素分析显示,肿瘤大小(χ2=5.099,P=0.035)、术前CEA水平(χ2=4.244,P=0.043)、淋巴结检出数量(χ2=9.875,P=0.002)及T分期(χ2=8.012,P=0.008)是Ⅱ期结肠癌患者的预后因素。多因素分析显示,淋巴结检出数量(P=0.017)和T分期(P=0.044)是影响Ⅱ期结肠癌患者的独立预后因素。淋巴结检出≥12个的患者生存时间明显长于淋巴结检出<12个的患者生存时间,P=0.002。结论:手术年代、肿瘤部位,肿瘤大小及T分期是结肠癌根治术淋巴结检出数量的重要影响因素。淋巴结检出数量是Ⅱ期结肠癌患者生存重要的独立预后因素,因此结肠癌根治术中检取足够的淋巴结有利于合理评估预后。

OBJECTIVE：To investigate affecting factors the number of lymph nodes（LNs） retrieved and prognostic value in stage Ⅱcolon cancer after radical surgery. METHODS： The clinicopathologic data were collected from 216 pa tients with stageⅡ colon cancer treated with curative surgery alone at the Department of Gastrointestinal Surgery,Fourth Affiliated Hospital,China Medical University from January 5th, 2000 to December 31st, 2009. The relationship between the number of LNs retrieved and clinicopathologic features was retrospectively analyzed. The univariate and multivariate Cox proportional hazard model and Kaplan-Meier method were used to analyze the prognosis and influencing factors. RE- SULTS： From 2000-01 to 2009-12 ,the proportion of individuals who had 12 or more LNs retrieved during a colectomy for stage Ⅱ colon cancer increased from 8.0% to 91.7G. The number of patients who had ≥12 LNs retrieved in 2005-2009 in right colon cancer,tumor size ≥5 cm and stage T4a- T4b were more than that of 2000-2004, left colon cancer, tumor size ≥5 cm and stage T3. Having ≥12 LNs retrieved had a significant correlation with operative period （X2 =45. 188,P〈 0. 001） ,tumor site （X2=5. 413,P=0. 020） ,tumor size （X2 =4. 021,P=0. 045） and T stage （X2 =8. 533,P=0. 014） but no significant correlation with gender, age, pathology, differentiation and preoperative CEA levels. Univariate prognostic a nalysis showed that tumor size （Xz =5. 099,P=0. 035） ,preoperative CEA levels （X2 =4. 244,P=0. 043） ,the number of LNs retrieved （X2 = 9. 875,P=0. 002） and T stage （X2 = 8. 012,P= 0. 008） were prognostic factors in stage R colon cancer. Multivariable Cox＇s proportional hazard model analysis showed that the number of LNs retrieved （P = 0. 017）and T stage（P=0. 044）were independent prognostic factors in stage Ⅱ colon cancer. Media survival of having ≥12 LNsretrieved was obviously higher than that of having%12 LNs retrieved （P=0. 002） in stage 1I colorectal cancer. CONCLU- SIONS= There is a significant correlation between having 12 LNs retrieved and operative period, tumor site, tumor size and stage. The number of LNs retrieved is the most important independent prognostic factors for survival of patients in stage Ⅱ colon cancer. Satisfied LNs resection in colon cancer radical surgery is beneficial for prognosis.