阳性淋巴结对数比分期预测Ⅲ期结肠癌预后的价值

Prognostic Superiority of Log Odds of Positive Lymph Nodes in Stage Ⅲ Colorectal Cancer

目的探讨阳性淋巴结对数比（LODDS）分期预测Ⅲ期结肠癌预后的价值。方法回顾性分析了2005年1月至2012年12月在北京协和医院就诊的175例Ⅲ期结肠癌患者的临床资料,比较了淋巴结N分期、淋巴结转移率（LNR）分期和LODDS分期对预后评估的价值。结果不同N分期（χ2=33.1,P=0.000）、LNR分期（χ2=14.3,P=0.001）和LODDS分期（χ2=14.9,P=0.001）的Ⅲ期结肠癌患者5年总生存率差异有统计学意义。单因素分析结果显示：TNM分期（χ2=27.0,P=0.000）、合并癌结节（χ2=3.6,P=0.040）、N分期（χ2=33.1,P=0.000）、LNR分期（χ2=14.3,P=0.001）、LODDS分期（χ2=30.4,P=0.000）与本组Ⅲ期结肠癌患者的预后相关。多因素分析结果显示：TNM分期（HR：1.84,95%CI：1.59～6.29,P=0.001）和LODDS分期（HR：1.34,95%CI：1.01～1.80,P=0.047）是本组Ⅲ期结肠癌患者总生存期的独立预后因素。结论 LODDS分期对于Ⅲ期结肠癌患者术后生存的预后预测具有重要意义。

Objective To evaluate the prognostic value of the log odds of positive lymph nodes （LODDS） in stage m colorectal cancer （CRC） patients who have undergone curative resection. Methods We performed a retrospective review of 175 stage 111 CRC patients who underwent curative resection in Peking Union Medical Col- lege Hospital from 2005 to 2012. Patients were categorized respectively according to the AJCC/UICC N grade, the metastatic lymph node ratio （LNR）, and the ratio of their LODDS. The relationship between the N grade, LNR, LODDS, and overall survival （OS） rates were assessed. Results The five-year disease-free survival （DFS） was significantly different among stage 111 CRC patients in different N grade （X2 = 33.1, P = 0. 000）, LNR （X2 = 14.3, P = 0. 001 ）, and LODDS （X2 = 14. 9, P = 0. 001 ） . Univariate analysis showed that TNM stage （X2=27.0, P=0.000）, cancerous node （X2=3.6, P=0.040）, N grade （X2=33.1, P=0.000）, LNR （X2 = 14.3, P =0. 001 ）, and LODDS （X2 =30. 4, P =0. 000） were related to OS. Multivariate analysis indicated that TNM stage （HR： 1.84, 95% CI： 1.59 ～ 6. 29, P = 0. 001 ） and LODDS classification （HR： 1.34, 95% CI： 1.01 - 1.80, P =0. 047） were independent prognostic factors for OS in stage m CRC patients. Conclusion LODDS is a good prognostic indicator in stage HI CRC patients who have undergone curative resec-