结直肠癌淋巴结检出数目影响因素分析及个体化评估展望

Factor analysis and the prospect of individualized evaluation for lymph node harvest in colorectal cancer

近年来,结直肠癌发病率及病死率不断上升,以手术为主的综合治疗策略是结直肠癌的主要治疗模式。结直肠癌术后淋巴结检出数目是评估外科手术质量和实现肿瘤精准分期的必要保障和前提,也对患者后续治疗决策有重要的临床意义。大量研究表明淋巴结检出数目受到整体治疗策略、手术切除方式、病理检出技术、患者个体差异及肿瘤异质性等多种因素影响,这也导致临床指南中要求“至少检出12枚淋巴结”的要求受到越来越多的争议。基于此现状,淋巴结个体化检出相关研究已成为该领域热点话题,这也是有望确保淋巴结检出具有科学性的重要手段和发展趋势。目前,多组学数据应用与人工智能分析等前沿技术也逐渐应用到淋巴结个体化检出的探索中,并取得了一定临床成果,但多数研究成果尚待转化。因此,我们也期待未来有更多高质量临床研究来探索淋巴结的个体化检出,从而更好完善临床分期和指导治疗及判定预后。

In recent years, the morbidity and mortality of colorectal cancer have been increasing, and the comprehensive treatment strategy based on surgery is the main treatment mode of colorectal cancer. The number of lymph nodes detected after colorectal cancer surgery is a necessary guarantee and prerequisite for evaluating the quality of surgery and achieving accurate tumor staging, and it also has important clinical significance for patients' follow-up treatment decisions. A large number of studies have shown that the number of lymph nodes detected is affected by various factors such as the overall treatment strategy, surgical resection, pathological detection techniques, individual differences in patients, and tumor heterogeneity. This has also led to increasing controversy over the requirement of "at least 12 lymph nodes to be harvested" in clinical guidelines. Based on this situation, the research on individualized detection of lymph nodes has become a hot topic in this field, which is also an important means and development trend that is expected to ensure the scientificity of lymph node detection. At present, cutting-edge technologies such as multi-omics data application and artificial intelligence analysis have also been gradually applied to the exploration of individualized detection of lymph nodes, and certain clinical results have been achieved, but most of the research results have yet to be transformed. Therefore, we also look forward to more high-quality clinical studies in the future to explore the individualized detection of lymph nodes, so as to better improve clinical staging, guide treatment and determine prognosis.