Vaccaro Carlos A, Bonadeo Fernando A, Benati Mario L, Quintana Guillermo M Ojea, Rubinstein Fernando, Mullen Eduardo, Telenta Margarita, Lastiri Jose M
Department of General Surgery, General Surgery Service, Division of Colorectal Surgery, Hospital Italiano de Buenos Aires, Argentina.
Dis Colon Rectum. 2004 Jan;47(1):66-9. doi: 10.1007/s10350-003-0004-y. Epub 2004 Jan 14.
Current American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM classification disregards location of positive nodes, discontinuing N3 category, which constitutes a major modification to 1987 version. This study was designed to assess the impact of the recategorization of former N3 cases and the reliability of the current N1-N2 subcategorization of Stage III patients.
Prospectively collected data from 1,391 patients (55.8 percent males; median age, 64 (range, 21-97) years), operated on with curative intent between 1980 and 1999, were analyzed. The median follow-up was 60 (interquartile range, 27-97) months with 129 cases lost to follow-up.
Of positive node cases, 25.3 percent were former N3. Among them, 30.5 percent migrated to the N1 group and 69.5 percent to the N2 group. The proportions of former N3 cases in N1 and N2 groups were 12.5 percent and 46.1 percent, respectively (P<0.001). Node-positive patients had an actuarial five-year survival rate of 56.7 percent (95 percent confidence interval, 53-59), with a significant difference between N1/N2 categories (63.6 vs. 44.1 percent, respectively; P<0.001). Although apical node involvement and more than three positive nodes were associated with poorer outcomes in univariate analysis, only the number of positive nodes had independent association (hazard ratio, 1.6 (range, 1.2-2.2); P<0.001). Integration of former N3 cases did not modify outcomes.
The recategorization of former N3 involved a high proportion of positive node cases. Current N1/N2 categories clearly defined different outcomes and were not modified by the integration of former N3.
美国癌症联合委员会和国际抗癌联盟当前的TNM分类未考虑阳性淋巴结的位置，取消了N3类别，这是对1987年版本的重大修改。本研究旨在评估重新分类前N3病例的影响以及当前III期患者N1-N2亚分类的可靠性。
分析了1980年至1999年间前瞻性收集的1391例患者（男性占55.8%；中位年龄64岁（范围21-97岁））的数据，这些患者接受了根治性手术。中位随访时间为60个月（四分位间距27-97个月），有129例失访。
在阳性淋巴结病例中，25.3%为前N3病例。其中，30.5%转移至N1组，69.5%转移至N2组。N1组和N2组中前N3病例的比例分别为12.5%和46.1%（P<0.001）。淋巴结阳性患者的5年精算生存率为56.7%（95%置信区间，53-59），N1/N2类别之间存在显著差异（分别为63.6%和44.1%；P<0.001）。尽管在单因素分析中，尖峰淋巴结受累和三个以上阳性淋巴结与较差的预后相关，但只有阳性淋巴结数量具有独立相关性（风险比，1.6（范围1.2-2.2）；P<0.001）。纳入前N3病例并未改变预后。
前N3病例的重新分类涉及较高比例的阳性淋巴结病例。当前的N1/N2类别明确界定了不同的预后，且未因纳入前N3病例而改变。
