淋巴结转移度对Ⅲ期结直肠癌术后远处转移的预测价值

Predictive value of lymph node ratio for postoperative distant metastasis of stage Ⅲ colorectal cancer

目的探讨淋巴结转移度（LNR）对结直肠癌术后远处转移的预测价值。方法回顾性分析解放军总医院普通外科2007年1月～2012年1月行根治性切除手术的180例结直肠癌患者的临床资料，按照术后有无出现远处转移将患者分为非转移组和转移组，分析LNR与结直肠癌术后出现远处转移的关系。结果非转移组118例（65．6％）；转移组62例（34．4％），其中肝转移39例，肺转移12例，骨、肺及多脏器转移11例。两组在肿瘤大体类型、分化程度、检出淋巴结总数及LNR方面差异有统计学意义（P〈0．05），溃疡型和浸润型较隆起型，低分化程度较高、中分化程度，LNR≥0．17较LNR〈0．17结直肠癌更易发生远处转移；多因素分析结果显示LNR与分化程度及大体类型均是影响结直肠癌术后远处转移的独立相关因素（RR：2．098；CI％：1．050．4．192；P=0．036）。结论LNR与结直肠癌术后发生远处转移独立相关，可联合分化程度等作为评估结直肠癌术后发生远处转移及预后的参考指标。

Objective To investigate the predictive value of metastatic lymph node ratio for postoperative distant metastasis in patients with colorectal cancer. Methods The clinicopathological data were collected from 180 patients with colorectal cancer who underwent surgical resection in General Hospital of PLA between from January, 2007 to January, 2012. The patients were divided into 2 groups according to the presence of distant organ metastasis and the clinicopathological factors were analyzed with Chi-square test and logistic regression. Results Of the 118 surgical patients enrolled, 118 were free of distant metastasis and 62 had distant metastasis involving the liver （39 cases）, lungs （12 cases）, and multiple organs （11 cases）. The gross types, differentiation, ELN and LNR of the tumors differed significantly between the two groups. Logistic regression analysis showed that LNR was an independent factor correlating to distant metastasis of colorectal cancer. Conclusion LNR is independently correlated with distant organ metastasis of colorectal cancer and serves as an important predicative factor for estimating the prognosis of colorectal cancer.