Ⅰ~Ⅲ期结直肠癌淋巴结转移比率与预后关系

Retrospective analysis of the relationship between metastatic lymph node ratio and survival in stage Ⅰ~Ⅲ colorectal cancer

目的评价Ⅰ~Ⅲ期结直肠癌淋巴结转移比率与患者预后的关系。方法回顾性分析中山大学附属第一医院胃肠胰腺外科2004年6月至2008年11月间446例行根治性切除的结直肠癌患者临床病理数据,探讨结直肠癌预后相关危险因素,评估结直肠癌淋巴结转移比率与患者预后的关系。结果 446例结直肠癌Ⅰ、Ⅱ、Ⅲ期患者的5年总体生存率分别约为87.4%,83.1%和64.8%(Log-rank检验,P<0.001)。我们根据淋巴结转移比率(metastatic lymph node ratio,mLNR)将CRC患者分为三组:A组:mLNR为0;B组:m LNR为>0%~14%;C组:mLNR为>14%。A、B、C组三组患者的5年总体生存率分别约为84.3%、79.6%和49.1%(Log-rank检验,χ2=55.959,P<0.001)。就直肠癌患者而言,A、B、C三组5年生存率分别为79.0%、73.5%和43.2%(Log-rank检验,χ~2=26.332,P<0.001)。而对于结肠癌患者来说三组的5年生存率分别为87.1%,80.8%和55.5%(Log-rank检验,χ~2=21.214,P<0.001)。单因素和多因素Cox分析均显示,mLNR是结直肠癌独立的预后危险因素,随着m LNR的上升,结直肠癌患者的预后变差。结论淋巴结转移比率(mLNR)是结直肠癌患者预后的独立危险因素,与N分期类似,但更有优势,可作为评估结直肠癌患者预后的指标之一。

Objective To retrospectively investigate the relationship between metastaticlymph node ratio and prognosis in stage I^III colorectal cancer. Methods The clinicopathologic data of446 patients with stage I^III colorectal cancer treated with curative resection at gastrointestinopancreaticsurgery department of the First Affiliated Hospital of Sun Yat-sen University was retrospectively analyzed.Factors including metastatic lymph node ratio, pT stage, chemoradiotherapy, gender, age, histological grade,histological type and tumor size were univariate and multivariate analyzed to investigate the correlatedprognostic risk factors in colorectal cancer. Results Among the 446 colorectal cancer patients, the overall5-year survival rates in NCCN stage I, II, III were 87.4%, 83.1%, 64.8% separately (P < 0.001). For therectal cancer subgroup, the overall 5-year survival rates in NCCN stage I, II, III were 86.5%, 73.7%, 56.2%separately (P<0.001). And for the colon cancer subgroup, the rates were 83.7%, 86.4% and 70.9% separately(P < 0.001). When putting the patients into three groups according to the metastatic lymph node ratio(cutoffs 0, >0%~14%, >14%), we found an overall 5year survival rates of 81.8%, 77.7% and 57.2% separately(χ2=55.959, P < 0.001) for the whole CRC patients. And the rates were 79.0%, 73.5% and 43.2% separately (χ2=26.332, P < 0.001) for the rectal cancer subgroup and 87.1%, 80.8 and 55.5% separately (χ2=21.214,P < 0.001) for the colon cancer subgroup. In univariate and multivariate analysis, metastatic lymph node ratio(mLNR) was found to be significantly associated with overall survival. The poor prognosis was associated withincreasing mLNR. In the rectal cancer subgroup and colon cancer subgroup, similar results were achieved.mLNR is an independent prognostic factors for colorectal cancer. Conclusions Metastatic lymph noderatio (mLNR) is an independent prognostic factor of colorectal cancer patients. The mLNR classification incolorectal cancer is similar with the pN stage classification, but more precise, in the prognostic assessment.