N2b期结直肠癌淋巴结转移指标与患者预后的关系

The association of metastasis-related indexes of lymph nodes and the prognosis of stage N2b colorectal cancer patients

目的探讨淋巴结转移相关指标对N2b期结直肠癌患者预后的评估价值。方法回顾性分析2007年1月至2012年12月在中国医学科学院肿瘤医院初治并接受根治性手术的245例N2b期结直肠癌患者的临床病理资料，探讨阳性淋巴结数、阴性淋巴结数、阳性淋巴结比例（LNR）和阳性淋巴结对数比（LODDS）与N2b期结直肠癌患者术后生存的关系，并研究各指标的预后评估价值。结果245例结直肠癌患者的5年总生存率为54.0%，5年无复发生存率为48.5%。单因素分析结果显示，神经侵犯或脉管瘤栓、T分期、术后辅助治疗、阳性淋巴结数、阴性淋巴结数、LNR和LODDS与患者的5年总生存率有关（均P〈0.05）。多因素分析结果显示，阳性淋巴结数、阴性淋巴结数、LNR和LODDS均为影响结直肠癌患者总生存的独立因素（均P〈0.05）。受试者工作特征曲线（ROC）分析显示，阳性淋巴结数、阴性淋巴结数、LNR和LODDS预测总生存的ROC曲线下面积相近，分别为0.649、0.667、0.690和0.683；阴性淋巴结数、LNR和LODDS与阳性淋巴结数预测总生存的ROC曲线下面积比较，差异均无统计学意义（均P〉0.05）。结论阳性淋巴结数、阴性淋巴结数、LNR、LODDS均为N2b期结直肠癌患者的独立预后因素。

Objective To evaluate the prognostic value of lymph node metastasis-related indexes in patients with stage N2b colorectal cancer. Methods Clinicopathologic data of 245 patients with stage N2b coloreetal cancer who initially underwent radical operation in Cancer Hospital, Chinese Academy of Medical Sciences between January 2007 and December 2012 were retrospectively analyzed. The prognostic values of several indexes, including number of positive lymph nodes, number of negative lymph nodes, lymph node ratio （LNR） and log odds of positive lymph nodes （LODDS） were analyzed. Results The 5-year overall survival rate of 245 patients with coloreetal cancer was 54.0%, and the 5-year recurrence-free survival rate was 48.5%. Univariate analysis showed that perincural or blood vessel invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR, and LODDS were significantly associated with the 5-year overall survival of colorectal cancer patients （P 〈 0.05）. Multivariate cox regression analysis showed that, number of positive lymph nodes, number of negative lymph nodes, LNR, LODDS were all independent prognostic factors for stage N2b colorectal cancer patients （P〈 0.05）. The areas under the receiver operating characteristic curve （ROC） curves of number of positive lymph node, number of negative lymph nodes, LNR and LODDS were 0.649, 0.667, 0.690 and 0.683, respectively, however, no statistical significance was observed between the number of negative lymph nodes （P=0.622）, LNR （P=0.178） or LODDS （P=0.272） and the number of positive lymph nodes. Conclusion The number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were all independent prognostic factors for patients with stage N2b colorectal cancer.