淋巴结检出数对直肠癌治疗影响的研究进展

Research advance on the effect of lymph node yield on rectal cancer treatment

目前直肠癌在我国发病率及病死率不断上升,各种有关直肠癌治疗和预后因素的研究在不断展开。病理分期不论对于直肠癌的治疗或是预后均具有重要意义。现阶段直肠癌的主要病理分期方法为肿瘤转移节点(tumor-node-metastasis,TNM)分期及Duke分期,肿瘤的分期结果可用来预测患者预后情况以及决定术后治疗方案。N分期取决于患者阳性淋巴结转移数。但N分期在对直肠癌预后的预测上存在局限性,而淋巴结检出数(lymph node yield,LNY)与淋巴结转移度(lymph node ratio,LNR)对分期及预后的意义逐渐受到人们的重视。LNY的增加有助于更准确的病理分期,改善患者预后,其主要受新辅助放射治疗和化学治疗、肿瘤解剖及病理性质如直径大小、浸润深度等以及患者自身因素影响;目前用于提高LNY的临床技术主要有脂肪清除法、染色剂淋巴示踪等,但都存在各自的局限性。LNR是将转移淋巴结数与LNY结合起来的一项指标。无论手术标本LNY是否足够,LNR比N分期对直肠癌的预后更具有意义。

With the continuous rise of the incidence and mortality of rectal cancer in China currently, various studies on the treatment and prognostic factors of rectal cancer are being conducted constantly. Pathological staging is of great significance no matter for the treatment or the prognosis of rectal cancer. At present, main pathological staging methods of rectal cancer are tumor-node-metastasis（TNM） staging and Duke staging. Staging results of tumors can serve as a tool to predict the prognosis of patients and determine postoperative treatment regimens. pN depends on the number of metastatic positive lymph nodes in patients. An increasing number of scholars have found that pN has limitations as per the prediction of the prognosis of rectal cancer, and that the significance of lymph node yield（LNY） and lymph node ratio（LNR） for staging and prognosis has gradually given rise to people＇s attention. The increase in LNY can contribute to a more accurate pathological staging and prognosis improvement of patients, and it is mainly subject to the influence of neoadjuvant chemoradiation, tumor anatomy and such pathological characteristics as diameter size, invasion depth and patients＇ own factors. Currently, clinical techniques aiming to increase LNY number include fat removal and lymphatic tracer, which, however, have their own limitations. LNR is an index combining the number of metastatic lymph nodes and LNY. Compared with pN, LNR is of greater significance for the prognosis of rectal cancer no matter the number of lymph nodes detected from surgical specimens suffices or not.