Tekkis Paris P, Smith Jason J, Heriot Alexander G, Darzi Ara W, Thompson Michael R, Stamatakis Jeffrey D
Department of Biosurgery and Surgical Technology, Imperial College London, St. Mary's Hospital, London, United Kingdom.
Dis Colon Rectum. 2006 Nov;49(11):1673-83. doi: 10.1007/s10350-006-0691-2.
This study was designed to develop a mathematical model for predicting the number of lymph nodes harvested in bowel cancer resection specimens based on the current clinical practice in the United Kingdom.
Prospective clinical data were collected from 8,409 newly diagnosed bowel cancer patients presenting to 79 hospitals in Great Britain and Ireland during a variable 12-month period from 2000 to 2002. A two-level hierarchical regression model was used to identify predictors for lymph node harvest. The model was internally validated by comparing observed and model predicted lymph node harvest for patient subgroups.
Inclusion criteria were satisfied by 5,164 patients. The average lymph node harvest was 11.7 nodes with significant between-center variability in lymph node harvest (range, 5.5-21.3 nodes). Increasing age, American Society of Anesthesiology grade, and preoperative radiotherapy were associated with a reduction of lymph node harvest (P < 0.001). Abdominoperineal resection of the rectum and transverse colectomy were the lowest yield procedures for lymph node harvest. Independent predictors of lymph node harvest were age, American Society of Anesthesiology grade, Dukes stage, operative urgency, type of resection, and preoperative radiotherapy. When tested, the model was found to accurately predict lymph node harvest for group statistics (comparison of observed and model predicted lymph node harvest F(1,5154) = 0.63; P = 0.427).
The results of the study suggest that the minimum number of lymph nodes harvested in colorectal cancer surgery cannot be set at a fixed value. The lymph node harvest model provides a simple tool to the frontline clinician for comparing standards between multidisciplinary bowel cancer teams.
本研究旨在基于英国当前的临床实践，开发一种数学模型，用于预测肠癌切除标本中获取的淋巴结数量。
前瞻性临床数据收集自2000年至2002年期间在英国和爱尔兰的79家医院就诊的8409例新诊断的肠癌患者，为期12个月，时间不等。采用两级分层回归模型来确定淋巴结获取的预测因素。通过比较患者亚组的观察到的和模型预测的淋巴结获取情况对模型进行内部验证。
5164例患者符合纳入标准。平均获取的淋巴结数量为11.7个，各中心之间的淋巴结获取存在显著差异（范围为5.5 - 21.3个）。年龄增加、美国麻醉医师协会分级以及术前放疗与淋巴结获取减少相关（P < 0.001）。直肠腹会阴切除术和横结肠切除术是获取淋巴结数量最少的手术方式。淋巴结获取的独立预测因素为年龄、美国麻醉医师协会分级、杜克分期、手术紧迫性、切除类型和术前放疗。经测试，发现该模型能准确预测组统计数据中的淋巴结获取情况（观察到的和模型预测的淋巴结获取情况比较F(1,5154) = 0.63；P = 0.427）。
研究结果表明，结直肠癌手术中获取的淋巴结最小数量不能设定为固定值。淋巴结获取模型为一线临床医生提供了一个简单工具，用于比较多学科肠癌治疗团队之间的标准。
