淋巴结大小对结直肠癌患者分期的影响以及与预后的关系

Influence of lymph node size on pathological staging of colorectal cancer patients and its relation with prognosis

目的探讨淋巴结大小对结直肠癌患者分期的影响以及与预后的关系。方法回顾性收集新都区人民医院2017–2021年期间择期手术的结直肠癌患者,采集可见和可触及的淋巴结并进行常规组织学检查,分析淋巴结大小对术后病理分期的影响以及与预后的关系。结果本研究最终纳入了300例结直肠癌患者,共清扫出淋巴结4442枚,有4086枚完成了淋巴结大小测量,其中发现阳性淋巴结198枚(共108例患者)。在直径<3 mm的微小淋巴结1360枚中检出32枚(共24例患者)阳性淋巴结,在该24例患者中仅有4例患者在检测大淋巴结(直径≥3 mm)时结果为阴性而在检测微小淋巴结(直径<3 mm)时却发现淋巴结阳性而改变了N分期。logistic回归分析结果显示,淋巴结直径<3 mm患者的淋巴结阳性概率较低(以淋巴结直径为3~6 mm患者作对照,OR=0.49,P=0.015)。本研究排除了4例因多源发行结肠次全切除而存在不同部位淋巴结混杂因素和4例患者淋巴结明显异常患者后纳入了292例分析,在292例整体患者以及其中106例淋巴结阳性患者中均未发现淋巴结大小与检出淋巴结数目有相关性(r=0.148、P=0.075;r=–0.032、P=0.821),也未发现检出淋巴结数目≥12枚和<12枚患者的淋巴结大小间的差异有统计学意义(P>0.05);但是在186例淋巴结阴性患者中发现淋巴结大小与检出淋巴结数目呈正相关关系(r=0.317,P=0.002),且检出淋巴结数目≥12枚者的淋巴结直径明显大于<12枚患者(P=0.002)。本研究中无论是在淋巴结阳性还是阴性患者中,不同淋巴结大小分组患者(<3 mm、3~6 mm及>6 mm)间的无病生存和总生存情况总体比较差异均无统计学意义(P>0.05)。结论从本研究分析结果看,淋巴结大小对淋巴结分期影响不大,并且在进行生存分析时发现无论是在淋巴结阳性或阴性患者中均未发现淋巴结大小与无病生存和总生存有关。

Objective To investigate the effect of lymph node size on the pathological stage of colorectal cancer patients and analyze the relation between lymph node size and prognosis.Methods The patients with colorectal cancer underwent elective surgery in the People’s Hospital of Xindu District from 2017 to 2021 were retrospectively collected.The visible and palpable lymph nodes were harvested and the routine histological examination was performed.The effect of lymph node size on the pathological stage and prognosis of colorectal cancer patients were analyzed.Results A total of 300 patients with colorectal cancer were enrolled,with harvested 4442 lymph nodes.Among them,measurement of lymph node size was completed in 4086 lymph nodes,198 lymph nodes(108 patients)of whom were found to be positive.There were 1360 small lymph nodes(diameter<3 mm),32 lymph nodes(24 patients)of whom were positive.Among the 24 patients,only 4 patients when detecting large lymph nodes(diameter≥3 mm)was negative,but which was positive when detecting small lymph nodes(diameter<3 mm).The results of logistic regression analysis showed that the lymph node diameter<3 mm had a lower probability of positive lymph node(lymph node diameter 3–6 mm as a reference,OR=0.49,P=0.015).After excluding 4 cases of subtotal colon resection and 4 patients with obvious abnormalities of lymph node,292 cases were included to analyze the relation between the lymph node size and the number of detected lymph nodes,no correlation was found between the lymph node size and the number of detected lymph nodes in 292 integral patients or 106 patients with positive lymph node(r=0.148,P=0.075;r=–0.032,P=0.821).Moreover,no statistical difference of the lymph node size was found between the patients with≥12 and<12 lymph nodes detected(P>0.05).However,in the 186 patients with negative lymph nodes,a positive correlation was found between the lymph node size and the number of detected lymph nodes(r=0.317,P=0.002),and lymph node diameter was significantly larger in the patients with≥12 lymph nodes detected than in the patients with<12 lymph nodes detected(P=0.002).There were no statistical differences in the disease-free survival and overall survival among the patients with different lymph node sizes(<3 mm,3–6 mm,and>6 mm)in both patients with positive and negative lymph nodes(P>0.05).Conclusion From the analysis results of this study,it is found that lymph node size has little effect on lymph node pathological staging,and no correlation between lymph node size and disease-free survival or overall survival is found in both patients with positive and negative lymph nodes.